Individual
RAVENWOLF MOONDRAGON INSERRA-LE CRONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 SHASTA DR, DAVIS, CA 95616-6691
(530) 747-7000
Mailing address
1515 SHASTA DR, DAVIS, CA 95616-6691
(530) 747-7000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT9712
CA
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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