Individual
LETICIA LACANILAO BALLESTEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1420 WILLOW PASS RD, CONCORD, CA 94520-5223
(925) 646-5480
Mailing address
114 MATTHEW CT, VALLEJO, CA 94591-4171
(707) 553-1385
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
516042
CA
Other
Enumeration date
01/22/2007
Last updated
07/08/2007
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