Individual
COREY LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
330 MOSS ST, CHULA VISTA, CA 91911-2005
(801) 602-0426
Mailing address
4545 ARIZONA ST APT 309, SAN DIEGO, CA 92116-5910
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95416500
CA
Other
Enumeration date
11/28/2025
Last updated
11/28/2025
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