Individual
GRACE GOTOS PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
2812 BREAKER WAY, STOCKTON, CA 95209-4265
(209) 351-7132
Mailing address
2812 BREAKER WAY, STOCKTON, CA 95209-4265
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT32760
CA
374700000X
Technician
PT32760
CA
Other
Enumeration date
11/25/2009
Last updated
04/16/2026
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