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1134624802
THARITH VONG
STOCKTON, CA
NPI
1134624802
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
167G00000X Licensed Psychiatric Technician
(Licence: CA 40678)
Enumeration Date
2018-03-26
Last Update Date
2018-03-26
Business Address
THARITH VONG
1212 N CALIFORNIA ST
STOCKTON, CA 95202-1552
Phone number: 209-468-0102
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Mailing Address
THARITH VONG
1212 N CALIFORNIA ST
STOCKTON, CA 95202-1552
Phone number: 209-468-0102
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