Individual
PANICHA KITTIPHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4475
Mailing address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4475
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
95005491
CA
Other
Enumeration date
11/16/2016
Last updated
11/16/2016
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