Individual
AUDREYANDRA LUCIA IMANSJAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2300 CAMINO RAMON, SAN RAMON, CA 94583-1354
(925) 244-7400
Mailing address
2300 CAMINO RAMON, SAN RAMON, CA 94583-1354
(925) 244-7400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17597
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2018
Last updated
04/21/2022
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