Individual
NICOLETTE DANIELE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
531 OHARA AVE, OAKLEY, CA 94561-5741
(925) 219-6165
Mailing address
531 OHARA AVE, OAKLEY, CA 94561-5741
(925) 219-6165
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
079200771
CA
Other
Enumeration date
09/20/2018
Last updated
06/01/2021
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