Individual
EVAN BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
703 LIANA DR, SANTA ROSA, CA 95407-7434
(650) 554-0355
Mailing address
703 LIANA DR, SANTA ROSA, CA 95407-7434
(650) 554-0355
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/13/2021
Last updated
05/13/2021
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