Individual
MR. JON CHARLES LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6368 HOLLYWOOD BLVD, LOS ANGELES, CA 90028-6320
(323) 469-5555
(323) 466-0405
Mailing address
6368 HOLLYWOOD BLVD, LOS ANGELES, CA 90028-6320
(323) 469-5555
(323) 466-0405
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA22770
CA
Other
Enumeration date
03/27/2013
Last updated
09/21/2016
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