| Nautico Incorporated | |
|
1420 W Kettleman Ln Suite R Lodi CA 95242-4557 | |
| (209) 334-2053 | |
| (209) 333-4414 |
| Full Name | Nautico Incorporated |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1420 W Kettleman Ln, Lodi, California |
| Authorized Official Name and Position | Beverly M Breakey (CLINICAL COORDINATOR) |
| Authorized Official Contact | 2093342053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nautico Incorporated 1420 W Kettleman Ln Suite R Lodi CA 95242-4557 Ph: (209) 334-2053 | Nautico Incorporated 1420 W Kettleman Ln Suite R Lodi CA 95242-4557 Ph: (209) 334-2053 |
| NPI Number | 1558666982 |
|---|---|
| Provider Enumeration Date | 01/15/2011 |
| Last Update Date | 01/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558666982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MFC30755 (California) | Primary |
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