Doctor Name: | SARUON MOUN-ELDRIDGE |
NPI Number: | 1205296688 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 5513-R |
Business Practice Address: | 1904 Richland Ave Ceres, CA - 953074562 |
Business Phone Number: | 2095412121 |
Business Fax Number: | |
Mailing Address: | 1904 Richland Ave, CERES |
State: | CA |
Postal Code: | 953074562 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/29/2016 |
NPI Last Update Date: | 02/29/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 5513-R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |