Most Relevant Information
Provider Data
| NPI Number: | 1003176801 |
| Provider Name: | RISA BOOC TUDTUD |
| Entity Type: | Individual |
| Taxonomy Code: | 261QM1300X |
| Specialty: | Clinic/Center |
| License Number: | 748247 |
Most Important Dates
| Enumeration Date: | 05/25/2012 |
| Last Updated: | 05/25/2012 |
Provider Practice Location
10760 N MAGNOLIA AVE
8B
SANTEE
CA
920711292
Practice Location Phone/Fax
| Phone: | 8585377007 |
| Fax: |
Provider Mailing Location
10760 N MAGNOLIA AVE
8B
SANTEE
CA
920711292
Provider Mailing Phone/Fax
| Phone: | 8585377007 |
| Fax: |