Individual
MISS AJA ELIS LOCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
641 CAMPUS DR, STANFORD, CA 94305-6201
(818) 795-7847
Mailing address
626 E ORANGE GROVE AVE APT 303, BURBANK, CA 91501-2884
(818) 861-7175
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
BOC2000041205
CA
Other
Enumeration date
11/19/2019
Last updated
02/02/2024
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