Individual
MR. ELIJAH WELLS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 W AVENUE J, LANCASTER, CA 93534
(818) 581-8645
Mailing address
11408 KELOWNA ST, LAKE VIEW TERRACE, CA 91342-7320
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95190628
CA
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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