Individual
ANNA JADWIGA HADILAKSONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
135 CARMEN LN, SANTA MARIA, CA 93458-7729
(805) 928-7361
Mailing address
128 LA COLIMA, PISMO BEACH, CA 93449-2841
(732) 754-3197
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95010045
CA
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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