Individual
CHRISTINE MARIE PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13223 BLACK MOUNTAIN RD # 1358, SAN DIEGO, CA 92129-2698
(619) 672-8387
Mailing address
13223 BLACK MOUNTAIN RD # 1358, SAN DIEGO, CA 92129-2698
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP34708
CA
Other
Enumeration date
03/15/2023
Last updated
03/15/2023
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