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Individual

JEREMIAH GACUSAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
251 LLEWELLYN AVE, CAMPBELL, CA 95008-1940
(916) 388-6372
(916) 779-2558
Mailing address
1335 OLD ABBEY PL, SAN JOSE, CA 95132-2527
(916) 388-6372
(916) 779-2558

Taxonomy

Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
29197
CA

Other

Enumeration date
06/13/2014
Last updated
06/13/2014
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