Individual
ASHLEY MARA STANTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3737 MARTIN LUTHER KING JR BLVD, LYNWOOD, CA 90262-3513
(123) 456-7899
Mailing address
831 W RAYMOND ST, COMPTON, CA 90220-4460
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/20/2011
Last updated
07/18/2011
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