Provider Demographics
NPI:1053813295
Name:RONNING, ANNALISA MARIE
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:MARIE
Last Name:RONNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:MARIE
Other - Last Name:RONNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:657 CAPILANO DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7022
Mailing Address - Country:US
Mailing Address - Phone:925-826-6250
Mailing Address - Fax:
Practice Address - Street 1:657 CAPILANO DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7022
Practice Address - Country:US
Practice Address - Phone:925-826-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF44967152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer