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MODESTO, CA
NPI1629829452
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2024-03-29
Last Update Date2024-03-29
Business Address
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1400 FLORIDA AVE STE 102
MODESTO, CA 95350-4446
Phone number: 209-573-6180
Mailing Address
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2500 ALLUVIAL AVE
CLOVIS, CA 93611-9544
Phone number: 559-701-2102