Individual
AJ LAND III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 W TOKAY ST, LODI, CA 95240-3965
(209) 563-0373
Mailing address
1111 W TOKAY ST, LODI, CA 95240-3965
(209) 330-7155
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
10/14/2019
Last updated
06/18/2025
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