Individual
ANTHONY BANAAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2450 CRAVEN ST BLDG 3300, SAN DIEGO, CA 92136-5599
(619) 556-7931
Mailing address
10647 CARMEL MOUNTAIN RD, SAN DIEGO, CA 92129-2034
(619) 316-2593
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
080802105
CA
Other
Enumeration date
10/12/2018
Last updated
10/12/2018
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