Individual
JASON DOUGLAS DELACUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2640 INDUSTRY WAY, LYNWOOD, CA 90262-4284
(310) 627-4525
Mailing address
2640 INDUSTRY WAY, LYNWOOD, CA 90262-4284
(310) 627-4525
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
226742
CA
Other
Enumeration date
05/27/2020
Last updated
05/27/2020
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