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1164167136
LISA PHETCHAMPHONE
CERES, CA
NPI
1164167136
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
164X00000X Licensed Vocational Nurse
(Licence: CA 713585)
Enumeration Date
2022-05-03
Last Update Date
2022-05-03
Business Address
LISA PHETCHAMPHONE
1768 MITCHELL RD
CERES, CA 95307-2156
Phone number: 209-353-4838
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Mailing Address
LISA PHETCHAMPHONE
1768 MITCHELL RD
CERES, CA 95307-2156
Phone number: 209-353-4838
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