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Individual

CEVIN JORDAN WHITE O'HAGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPT

Contact information

Practice address
303 POTRERO ST STE 304, SANTA CRUZ, CA 95060-2741
(831) 420-0120
(831) 420-1057
Mailing address
303 POTRERO ST STE 42-103, SANTA CRUZ, CA 95060-2779
(831) 420-0120
(831) 420-1057

Taxonomy

Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
33563
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
44AV
MEDI-CAL PRV NBR
CA
Enumeration date
07/07/2009
Last updated
07/08/2009
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