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Individual

PRASEUTH SOUVANNAVONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2740 S BRISTOL ST, 218, SANTA ANA, CA 92704-6209
(714) 754-8200
(714) 754-8201
Mailing address
2740 S BRISTOL ST, 218, SANTA ANA, CA 92704-6209
(714) 754-8200
(714) 754-8201

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Enumeration date
03/26/2010
Last updated
11/30/2010
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