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1124252077
KELLY ANN ANTISTA SULTAN
SAN LUIS OBISPO, CA
NPI
1124252077
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Former Name
KELLY ANN ANTISTA
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2009-05-06
Last Update Date
2015-08-13
Business Address
-- KELLY ANN ANTISTA SULTAN
3765 S HIGUERA ST STE 100
SAN LUIS OBISPO, CA 93401-1570
Phone number: 805-781-3535
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Mailing Address
-- KELLY ANN ANTISTA SULTAN
1828 FIXLINI ST. APT B
SAN LUIS OBISPO, CA 93401
Phone number: 805-602-0733
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