NPI 1063977460
Gardner Carlson
Practice location
- Address
- 2225 Challenger Way, Santa Rosa, CA 95407-5441
- Phone
- (707) 565-4970
- Fax
- (707) 565-5183
Registered specialties
Licensed Psychiatric Technician
Primary
Registry record
- NPI
- 1063977460
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 10 Feb 2019
- Record last updated
- 10 Feb 2019
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.