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Vivian Tanudjaja
NPI 1831692086 · on the registry since 2018 · sole proprietor
Practice
- Address
- 6481 Atlantic Ave Apt 135
Long Beach, CA 90805 - Phone
- (562) 612-5696
Registry record
- Primary taxonomy
- Athletic Trainer
2255A2300X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2018-03-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California