NI KETUT SUPIYATI

HUNTINGTON PARK, CA
NPI1023497443
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: CA  NP95001498)
Enumeration Date2015-05-19
Last Update Date2015-05-19
Business Address
-- NI KETUT SUPIYATI
2638 E FLORENCE AVE
HUNTINGTON PARK, CA 90255-4708
Phone number: 323-581-4665
Mailing Address
-- NI KETUT SUPIYATI
2638 E FLORENCE AVE
HUNTINGTON PARK, CA 90255-4708
Phone number: 323-581-4665
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