Individual
GRACIELA PEREZ PONCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3820 MARTIN LUTHER KING JR BLVD, LYNWOOD, CA 90262-3625
(310) 632-0421
Mailing address
1567 E 22ND ST, LOS ANGELES, CA 90011-1350
(323) 836-4566
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
08/15/2018
Last updated
08/15/2018
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