Individual
WATHANA SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
U
Contact information
Practice address
1315 WOODCREEK WAY, STOCKTON, CA 95209-2050
(209) 817-2921
Mailing address
1315 WOODCREEK WAY, STOCKTON, CA 95209-2050
(209) 817-2921
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
—
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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