Individual
LISA CROCKOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1838 E. BADILLO STREET APT 1, LOS ANGELES, CA 90001
(626) 324-2190
Mailing address
1838 E BADILLO ST APT 1, WEST COVINA, CA 91791-1107
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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