LYSHAWN XATIY PHOMMAKHOTH

SACRAMENTO, CA
NPI1306627260
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: CA  64438)
Enumeration Date2023-10-06
Last Update Date2024-08-07
Business Address
LYSHAWN XATIY PHOMMAKHOTH
8120 TIMBERLAKE WAY STE 108
SACRAMENTO, CA 95823-5413
Phone number: 916-252-5000
Mailing Address
LYSHAWN XATIY PHOMMAKHOTH
9534 KELLEY DR
STOCKTON, CA 95209-1578
Phone number: 209-487-3891
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