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Tanner Gustavsen
Student in an Organized Health Care Education/Training Program in San Diego, California
NPI 1952978082

Tanner Gustavsen is a Student in an Organized Health Care Education/Training Program based in Boise, CA. Tanner Gustavsen practices in San Diego, CA. The NPI Number for Tanner Gustavsen is 1952978082 and holds a License No. (California).

The current practice location address for Tanner Gustavsen is 4077 Fifth Ave # Mer-35, San Diego, CA and can be reached out via phone at 208-272-1194.

Location: 4077 Fifth Ave # Mer-35, San Diego, CA, 83702-1359
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1952978082
Provider Name
Tanner Gustavsen
Credential
Provider Entity Type
Individual
Gender
Male
Address
4077 Fifth Ave # Mer-35, San Diego, CA, 83702-1359
Phone Number
208-272-1194
Fax Number
Provider Enumeration Date
06/08/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
4077 Fifth Ave # Mer-35
City
San Diego
State
California
Zip
92103-2105
Phone Number
208-272-1194
Fax Number
person
Provider Business Mailing Address Details
Address
4077 Fifth Ave # Mer-35
City
San Diego
State
California
Zip
92103-2105
Phone Number
208-272-1194
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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