Individual
MUACONG MARTIN LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MENTAL HEALTH
Contact information
Practice address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-8661
Mailing address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-8661
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42402
CA
Other
Enumeration date
07/28/2022
Last updated
03/22/2023
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