Individual
LOIS ANN BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3608 KODIAK WAY, ANTELOPE, CA 95843-2304
(916) 627-5426
Mailing address
3608 KODIAK WAY, ANTELOPE, CA 95843-2304
(916) 627-5426
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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