Individual
SHAYANE VALENZUELA SANTIAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
846/848 GRAVENSTEIN HWY S., SEBASTOPOL, CA 95472
(323) 403-7476
Mailing address
846 GRAVENSTEIN HIGHWAY SOUTH, SEBASTOPOL, CA 95472
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003308313
N/A
—
Enumeration date
06/01/2018
Last updated
03/09/2022
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