Individual
CARISSA LEE GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
119 LINCOLN BLVD, VENICE, CA 90291-2807
(310) 392-3983
Mailing address
119 LINCOLN BLVD, VENICE, CA 90291-2807
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
42171
CA
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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