Individual
CONNIE DESAUTELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
166 SANTA CLARA AVE, OAKLAND, CA 94610-1323
(510) 601-1929
Mailing address
166 SANTA CLARA AVE, OAKLAND, CA 94610-1323
(510) 601-1929
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
CA
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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