Individual
WANCHAI CHUANGSAMRONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
315 PALOMAR CT, SAN BRUNO, CA 94066-4711
(415) 490-6434
Mailing address
315 PALOMAR CT, SAN BRUNO, CA 94066-4711
(415) 490-6434
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
288518
CA
225700000X
Massage Therapist
Primary
89210
CA
Other
Enumeration date
08/25/2022
Last updated
08/25/2022
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