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1467214403
DERRICK ACE PHOMMACHIT
NEWARK, CA
NPI
1467214403
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2024-01-25
Last Update Date
2024-01-25
Business Address
DERRICK ACE PHOMMACHIT
39899 BALENTINE DR STE 110
NEWARK, CA 94560-5356
Phone number: 855-223-7123
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Mailing Address
DERRICK ACE PHOMMACHIT
PO BOX 33568
SAN DIEGO, CA 92163-3568
Phone number: 855-223-7123
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