Individual
GRACE PUDDOC WILBUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
921 S BEACON ST, SAN PEDRO, CA 90731-3740
(310) 984-3055
Mailing address
921 S BEACON ST, SAN PEDRO, CA 90731-3740
(310) 984-3055
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN139298
CA
Other
Enumeration date
03/25/2008
Last updated
03/25/2008
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