Individual
HANAH JAYMES MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12193 CUSTER ST, YUCAIPA, CA 92399-4485
(909) 499-0804
Mailing address
12193 CUSTER ST, YUCAIPA, CA 92399-4485
(909) 499-0804
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95221802
CA
Other
Enumeration date
01/25/2021
Last updated
03/22/2024
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