Individual
ANNA GAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1256 W. LATHROP RD #376, MANTECA, CA 95336
(925) 263-9331
Mailing address
1256 W. LATHROP RD #376, LATHROP, CA 95330
(925) 263-9331
Taxonomy
Speciality
Code
Description
License number
State
171WV0202X
Vehicle Modifications Contractor
—
—
172A00000X
Driver
Primary
—
CA
Other
Enumeration date
06/10/2016
Last updated
02/22/2024
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