Individual
PRISCILLA MAMEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
825 12TH ST, MODESTO, CA 95354-2333
(209) 525-5050
Mailing address
825 12TH ST, MODESTO, CA 95354-2333
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
786289
CA
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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