Individual
VIVIAN TANUDJAJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6481 ATLANTIC AVE APT 135, LONG BEACH, CA 90805-2339
(562) 612-5696
Mailing address
6481 ATLANTIC AVE APT 135, LONG BEACH, CA 90805-2339
(562) 612-5696
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
03/14/2018
Last updated
03/14/2018
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