Individual
KIMBERLY LATOYA GANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-8700
Mailing address
3222 JONATHEN ST, STOCKTON, CA 95206-5916
(209) 817-7301
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
36498
CA
Other
Enumeration date
06/11/2012
Last updated
06/11/2012
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