Individual
ME'LISA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1670 E 120TH ST, LOS ANGELES, CA 90059-3026
(424) 338-2937
Mailing address
1670 E 120TH ST, LOS ANGELES, CA 90059-3026
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
95227389
CA
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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