Individual
SHO KITADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14677 MERRILL AVE., FONTANA, CA 92335
(951) 643-2340
Mailing address
2126 EADBURY AVE, ROWLAND HEIGHTS, CA 91748-4030
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41070
CA
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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