Individual
RENATA ODONGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT,CKTP. CGT
Contact information
Practice address
4710 N 5TH ST, PHOENIX, AZ 85012-1738
(816) 262-1979
Mailing address
4410 S. VAL VISTA DR., APT 2089, MESA, AZ 85204-6447
(816) 262-1979
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
AZ
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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