Individual
MISS ELISE LA KEISHA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
172V00000X
Contact information
Practice address
921 E COMPTON BLVD, COMPTON, CA 90221-3303
(310) 668-6947
(310) 898-1607
Mailing address
921 E COMPTON BLVD, COMPTON, CA 90221-3303
(310) 668-6947
(310) 898-1607
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/05/2017
Last updated
05/05/2017
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