Individual
MARK THIELENHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
622 N SACRAMENTO ST, LODI, CA 95240-1256
(209) 367-9560
Mailing address
525 W LOCKEFORD ST, LODI, CA 95240-1946
(209) 369-5896
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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