Individual
LYSA QUEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
643 S BUTTE ST, SAN PEDRO, CA 90732-3510
(310) 831-5700
Mailing address
643 S BUTTE ST, SAN PEDRO, CA 90732-3510
(310) 831-5700
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
6480
CA
Other
Enumeration date
10/12/2009
Last updated
10/12/2009
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