Individual
MISS LISA STEPHANIE WILKIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HHP
Contact information
Practice address
1901 1ST AVE, STE 221, SAN DIEGO, CA 92101-2356
(858) 205-9003
Mailing address
PO BOX 22063, SAN DIEGO, CA 92192-2063
(858) 205-9003
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4047
CA
Other
Enumeration date
11/07/2010
Last updated
11/07/2010
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