Individual
TONYA NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4545 GEORGETOWN PL STE A3, STOCKTON, CA 95207-6228
(209) 280-2362
Mailing address
4545 GEORGETOWN PL STE A3, STOCKTON, CA 95207-6228
(209) 280-2362
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT26756
CA
247200000X
Other Technician
PT26756
CA
Other
Enumeration date
10/04/2011
Last updated
07/03/2024
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