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1053699850
JACQUENE J RICHARDSON
LOS ANGELES, CA
NPI
1053699850
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
167G00000X Licensed Psychiatric Technician
(Licence: CA pt36012)
Enumeration Date
2011-07-27
Last Update Date
2011-08-01
Business Address
Mrs. JACQUENE J RICHARDSON
3875 S WESTERN AVE
LOS ANGELES, CA 90062-1105
Phone number: 323-290-4373
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Mailing Address
Mrs. JACQUENE J RICHARDSON
498 W. 59TH STREET
SAN BERNARDINO, CA 92407
Phone number: 323-290-4373
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