Individual
ELIZHA-GRACE FONTANILLA FULGENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4606 108TH ST SW, LAKEWOOD, WA 98499-4146
(253) 693-2626
Mailing address
1107 E 72ND ST, TACOMA, WA 98404-5801
(206) 419-8952
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
WA
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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