Individual
CANDICE LYNN BROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3211 W IMPERIAL HWY, INGLEWOOD, CA 90303-2810
(310) 419-9616
(310) 590-1357
Mailing address
3211 W IMPERIAL HWY, INGLEWOOD, CA 90303-2810
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CAS10488
CA
Other
Enumeration date
03/03/2012
Last updated
03/03/2012
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