Individual
LACEY CATHERINE GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1045 9TH AVE, SAN DIEGO, CA 92101-5504
(619) 235-2600
Mailing address
1045 9TH AVE, SAN DIEGO, CA 92101-5504
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-GSROVI
CA
Other
Enumeration date
08/29/2024
Last updated
09/24/2024
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