Individual
CARISSA LEWALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
614 E J ST, ONTARIO, CA 91764-2820
(909) 576-6427
Mailing address
614 E J ST, ONTARIO, CA 91764-2820
(909) 576-6427
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/30/2019
Last updated
04/30/2019
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