Organization
LICE CLINICS OF AMERICA LAX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO DANNY ESQUIVEL SR. (OWNER/TECH)
(310) 999-5343
Entity
Organization
Contact information
Practice address
5587 W MANCHESTER AVE, LOS ANGELES, CA 90045-4413
(310) 999-5343
Mailing address
11912 BRAY ST, CULVER CITY, CA 90230
(310) 999-5343
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/05/2017
Last updated
12/05/2017
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