Individual
ADISORN WANNAVIROJ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1025 ATLANTIC AVE STE 101, ALAMEDA, CA 94501-1188
(510) 268-8120
Mailing address
2026 BALBOA ST, SAN FRANCISCO, CA 94121-3024
(415) 828-8784
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
CA
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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