Individual
MRS. LISA MARIE KRUITBOSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 PRICE ST, PISMO BEACH, CA 93449-2534
(805) 773-2324
(805) 773-2327
Mailing address
900 PRICE ST, PISMO BEACH, CA 93449-2534
(805) 773-2324
(805) 773-2327
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
ABO145453
CA
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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