Provider Information for 1437296597
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Ms. SUSHMA RANI PATLA LMFT
Other Names:Former Name:SUSHMA RANI MADAHARSex: Female
NPI: 1437296597
Last Updated: 2019-06-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1437296597 | ||||||||
| Enumeration Date | 2007-01-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3636 GAMBLE OAK LANE STOCKTON, CA 95205 United States Phone: 510-921-4059 | Fax:209-451-1048 | ||||||||
| Primary Practice Address | 800 SCENIC DRIVE MODESTO, CA 95350 United States Phone: 209-525-7339 | Fax:209-558-4321 | ||||||||
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