Individual
MR. PETER WANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, EMT
Contact information
Practice address
3034 BELMONT DR, LODI, CA 95242-9732
(209) 625-9585
Mailing address
3034 BELMONT DR, LODI, CA 95242-9732
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
BOC069502723
CA
Other
Enumeration date
10/05/2020
Last updated
10/05/2020
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