Individual
BETHANY SUSANNE MAGNUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
721 BRENTWOOD DR, SANTA ROSA, CA 95405-6607
(785) 410-8246
Mailing address
721 BRENTWOOD DR, SANTA ROSA, CA 95405-6607
(785) 410-8246
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
070502037
CA
Other
Enumeration date
06/12/2018
Last updated
06/12/2018
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