Individual
LARONDA FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1209 INGALLS ST, SAN FRANCISCO, CA 94124-2801
(415) 822-1585
Mailing address
1209 INGALLS ST, SAN FRANCISCO, CA 94124-2801
(415) 822-1585
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
04/03/2017
Last updated
04/07/2017
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