ETHAN J GONSALVES

SAN LUIS OBISPO, CA
NPI1053035402
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA  r1475210722)
Enumeration Date2022-09-29
Last Update Date2022-09-29
Business Address
ETHAN J GONSALVES RADT
34 PRADO
SAN LUIS OBISPO, CA 93401
Phone number: 805-519-1405
Mailing Address
ETHAN J GONSALVES RADT
34 PRADO
SAN LUIS OBISPO, CA 93401
Phone number: 805-519-1405
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