Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 44227 | CA |
NPI | 1134272727 |
---|---|
Provider Name | Ms. Joanie Mc Culloch |
First Address | Stockton, CA 95209 |
Second Address | Stockton, CA 95209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 15/03/2019 |