Individual
JULIANNA AMY WIDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCTMB, BS,
Contact information
Practice address
3505 CAMINO DEL RIO S STE 100, SAN DIEGO, CA 92108-4015
(619) 246-1112
Mailing address
734 BUSH ST, SAN DIEGO, CA 92103-2903
(619) 246-1112
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
CA
225700000X
Massage Therapist
Primary
613930-12
CA
Other
Enumeration date
06/27/2023
Last updated
06/27/2023
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