Individual
MRS. GINA THERESA LANNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, CSCS
Contact information
Practice address
1600 HENDERSON AVE BLDG 573, SAN DIEGO, CA 92140-5000
(619) 524-4101
Mailing address
9073 COVINA ST, SAN DIEGO, CA 92126-3717
(619) 865-3219
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
030002048
CA
Other
Enumeration date
02/05/2019
Last updated
02/05/2019
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