Individual
ATH KITTIPHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 281-8467
(209) 558-4873
Mailing address
1216 COLLIER AVE, MODESTO, CA 95350-5302
(209) 499-4621
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
02/22/2016
Last updated
05/27/2025
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