Provider Information for 1376980227
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WANDA RAMONA BOUTTE
Other Names:Professional Name:WANDA RAMONA BOUTTE LCSWSex: Female
NPI: 1376980227
Last Updated: 2024-11-22
Certification Date: 2024-11-22
Certification Date: 2024-11-22
Details
| Name | Value | ||||||||||||
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| NPI | 1376980227 | ||||||||||||
| Enumeration Date | 2013-06-02 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5241 MEDEA WAY ANTIOCH, CA 94531-8727 United States Phone: 510-469-1136 | Fax: | ||||||||||||
| Primary Practice Address | 5241 MEDEA WAY ANTIOCH, CA 94531-8727 United States Phone: 510-469-1136 | Fax: | ||||||||||||
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