LUIS ANTHONY PROVENCIO

BAKERSFIELD, CA
NPI1750691887
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2010-10-07
Last Update Date2010-10-07
Business Address
Mr. LUIS ANTHONY PROVENCIO
1018 21ST ST
BAKERSFIELD, CA 93301-4709
Phone number: 661-861-9967
Mailing Address
Mr. LUIS ANTHONY PROVENCIO
1018 21ST ST
BAKERSFIELD, CA 93301-4709
Phone number: 661-861-9967
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