Individual
NERISSA PENOLA WELZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4930 WYCONDA LN, SAN DIEGO, CA 92113-3565
(619) 586-0772
Mailing address
6105 CHADWICK AVE, SAN DIEGO, CA 92139-3609
(619) 829-4828
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E1275699
DRIVER LICENSE
CA
Enumeration date
10/10/2023
Last updated
10/10/2023
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