Individual
MS. GWEN MANCUSO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
304 TIDEWAY DR, ALAMEDA, CA 94501-3511
(510) 375-6234
Mailing address
304 TIDEWAY DR, ALAMEDA, CA 94501-3511
(510) 375-6234
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
812190
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17
HOMEMAKER CARE
CA
Enumeration date
03/16/2006
Last updated
07/08/2007
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