Individual
LACIE PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4512 ACTRIZ PL, MARTINEZ, CA 94553-1459
(909) 244-7891
Mailing address
4512 ACTRIZ PL, MARTINEZ, CA 94553-1459
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
BOC194700
CA
Other
Enumeration date
01/25/2017
Last updated
01/25/2017
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