Individual
LACEE MARIE CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 788-3200
(951) 788-3200
Mailing address
PO BOX 79495, CORONA, CA 92877-0183
(951) 788-3000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA21251
CA
Other
Enumeration date
12/06/2010
Last updated
09/14/2013
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