Healthcare Provider Details

I. General information

NPI: 1871340265
Provider Name (Legal Business Name): RHIANNON GEVING MATRN, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 SAINT MARYS RD
MORAGA CA
94575-2744
US

IV. Provider business mailing address

1928 SAINT MARYS RD
MORAGA CA
94575-2715
US

V. Phone/Fax

Practice location:
  • Phone: 925-631-4398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: