Individual
MA TANIA DE JESUS MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18111 NORDHOFF ST, NORTHRIDGE, CA 91330-8200
(818) 770-9693
Mailing address
19709 GRESHAM ST, NORTHRIDGE, CA 91324-3316
(818) 770-9693
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/09/2020
Last updated
06/09/2020
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