Individual
TRACY CORNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
136 N SAN MATEO DR, SUITE 101, SAN MATEO, CA 94401-2777
(650) 373-0777
(650) 373-0778
Mailing address
521 ROCKY WAY, POBOX 620703, WOODSIDE, CA 94062-4021
(650) 599-9419
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT29823
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT29823
LPT
CA
Enumeration date
02/05/2007
Last updated
07/08/2007
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