Cdcr
NPI #1134558240 in Ione, California
Provider Information
- NPI Number
- 1134558240
- Entity Type
- Organization
- Organization Name
- Cdcr
- Primary Specialty
- Psychologist
- Enumeration Date
- Nov 8, 2013
- Last Updated
- Nov 8, 2013
Practice Location
- Address
- 4001 HIGHWAY 104
- City
- Ione
- State
- California
- ZIP Code
- 95640
- Phone
- (209) 274-4911
Authorized Official
- Name
- KO BRUCE FANG, PH.D.
- Title
- PSYCHOLOGIST
- Phone
- (209) 274-4911
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist |
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