Individual
DAISY PROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1891 EFFIE ST, LOS ANGELES, CA 90026-1711
(424) 653-6697
Mailing address
1891 EFFIE ST, LOS ANGELES, CA 90026-1711
(424) 653-6697
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95025343
CA
Other
Enumeration date
05/29/2023
Last updated
06/13/2024
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