Individual
THALIA LEBOGANG BRUCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5519 BONNER AVE APT 2, NORTH HOLLYWOOD, CA 91601-5723
(661) 993-8542
Mailing address
5519 BONNER AVE APT 2, NORTH HOLLYWOOD, CA 91601-5723
(661) 993-8542
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95192120
CA
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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