Individual
LONNIE TANENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1516 SAN ANSELMO AVE, APT B, SAN ANSELMO, CA 94960-1863
(415) 685-4493
Mailing address
1516 SAN ANSELMO AVE, APT B, SAN ANSELMO, CA 94960-1863
(415) 685-4493
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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