Provider Demographics
NPI:1033805478
Name:ASIAN PACIFIC SELF-DEVELOPMENT AND RESIDENTIAL ASSOCIATION
Entity Type:Organization
Organization Name:ASIAN PACIFIC SELF-DEVELOPMENT AND RESIDENTIAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-513-7618
Mailing Address - Street 1:3830 ALVARADO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-2350
Mailing Address - Country:US
Mailing Address - Phone:209-513-7618
Mailing Address - Fax:209-941-9516
Practice Address - Street 1:3830 ALVARADO AVE STE C
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-2350
Practice Address - Country:US
Practice Address - Phone:209-944-1700
Practice Address - Fax:209-941-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty