Individual
MRS. KYLENE RICHAN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2570 98TH AVE, OAKLAND, CA 94605-4746
(530) 644-3758
(530) 644-3782
Mailing address
PO BOX 586, CAMINO, CA 95709-0586
(530) 644-3758
(530) 644-3782
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5558
CA
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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