Individual
GINA VANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCHT
Contact information
Practice address
3030 BRIDGEWAY, STE 242, SAUSALITO, CA 94965-2810
(415) 275-4221
Mailing address
3030 BRIDGEWAY, STE 242, SAUSALITO, CA 94965-2810
(415) 275-4221
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CCHT
CA
Other
Enumeration date
04/10/2017
Last updated
04/10/2017
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