Individual
MRS. LONI ISHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
511 RUSTIC CT, RIPON, CA 95366-9507
(209) 612-8609
Mailing address
511 RUSTIC CT, RIPON, CA 95366-9507
(209) 612-8609
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
38233
CA
Other
Enumeration date
06/19/2016
Last updated
06/19/2016
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