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Individual

LAKEITH LACEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2315 LAGO VENTANA, CHULA VISTA, CA 91914-0000
(805) 908-2173
Mailing address
2315 LAGO VENTANA, CHULA VISTA, CA 91914-0000

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
104
CA

Other

Enumeration date
09/03/2015
Last updated
09/08/2015
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