CDCR

IONE, CA
NPI1134558240
Entity TypeOrganization
Authorized ContactKO BRUCE FANG
Psychologist
209-274-4911
Organization Subpart ?No
Primary Taxonomy103T00000X Psychologist
(Licence: CA  PSY18841)
Enumeration Date2013-11-08
Last Update Date2013-11-08
Business Address
CDCR
4001 HIGHWAY 104
IONE, CA 95640
Phone number: 209-274-4911
Mailing Address
CDCR
5215 LOTUS POND WAY
ELK GROVE, CA 95757-4342
Phone number: 916-296-5089
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