Individual
MR. BIBIN CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
535 PEREGRINE DR, PATTERSON, CA 95363-8703
(209) 892-4710
Mailing address
1548 CANAL FARM LN APT 6C, LOS BANOS, CA 93635-4430
(310) 874-7766
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/03/2020
Last updated
09/03/2020
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