Individual
PONGMAKTHIKRAKSORIVO PATRICK SISOWATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10425 PAINTER AVE, SANTA FE SPRINGS, CA 90670-3429
(562) 906-2685
Mailing address
12070 TELEGRAPH RD, SANTA FE SPRINGS, CA 90670-3771
(562) 777-7500
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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