Jack Lee Nicholson I
NPI #1831748318 in Lathrop, California
Provider Information
- NPI Number
- 1831748318
- Entity Type
- Individual
- Name
- Jack Lee Nicholson I
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Technician - Attendant Care Provider
- Enumeration Date
- Sep 8, 2019
- Last Updated
- Sep 8, 2019
Practice Location
- Address
- 460 AZTEC LN
- City
- Lathrop
- State
- California
- ZIP Code
- 95330-9142
- Phone
- (209) 451-8732
Specialties & Taxonomy Codes
| Specialty |
|---|
| Technician - Attendant Care Provider — Attendant Care Provider |
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