Individual
MRS. JEANNI CLANCEY LANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
612 D ST, SAN RAFAEL, CA 94901
(415) 454-6058
(415) 454-6078
Mailing address
PO BOX 478, FIARFAX, CA 94978-0478
(415) 454-6058
(415) 454-6078
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CFM00640
ABC
CA
Enumeration date
03/26/2007
Last updated
07/08/2007
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