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Individual

DR. ONTARIO DEPREE LACEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-3300
(619) 532-9795
Mailing address
612 ARTISAN RD, THOUSAND OAKS, CA 91320-5702
(805) 953-5993

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary

Other

Enumeration date
05/18/2015
Last updated
05/18/2015
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