Individual
LACI ESCLOVON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1105 N EL DORADO ST, STOCKTON, CA 95202-1305
(209) 938-0228
(209) 938-0281
Mailing address
1105 N EL DORADO ST, STOCKTON, CA 95202-1305
(209) 938-0228
(209) 938-0281
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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