Individual
JACQUELYN BANOUVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3 MORTON DR, DALY CITY, CA 94015-4415
(415) 407-0561
Mailing address
3 MORTON DR, DALY CITY, CA 94015-4415
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/02/2022
Last updated
05/02/2022
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