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1326620014
NICHOLAS GANNON
STOCKTON, CA
NPI
1326620014
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: CA 20A20458)
Enumeration Date
2021-04-22
Last Update Date
2023-01-29
Business Address
NICHOLAS GANNON DO
1800 N CALIFORNIA ST
STOCKTON, CA 95204-6019
Phone number: 209-547-5716
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Mailing Address
NICHOLAS GANNON DO
1800 N CALIFORNIA ST
STOCKTON, CA 95204-6019
Phone number:
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