Provider Demographics
NPI:1669684890
Name:TODT, RHONDA ADELE (L P T)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:ADELE
Last Name:TODT
Suffix:
Gender:F
Credentials:L P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5625
Mailing Address - Country:US
Mailing Address - Phone:209-406-1428
Mailing Address - Fax:
Practice Address - Street 1:1947 N CALIFORNIA ST
Practice Address - Street 2:SUITE C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6029
Practice Address - Country:US
Practice Address - Phone:209-463-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26776167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician