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Individual

LATASHA FULLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
31764 CASINO DR, LAKE ELSINORE, CA 92530-2312
(951) 471-4645
Mailing address
31764 CASINO DR, LAKE ELSINORE, CA 92530-2312

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary

Other

Enumeration date
01/24/2023
Last updated
01/24/2023
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