Individual
STEPHANIE DENESE DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
240 N BREED ST, LOS ANGELES, CA 90033-2903
(310) 493-4183
Mailing address
240 N BREED ST, LOS ANGELES, CA 90033-2903
(310) 493-4183
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/18/2024
Last updated
06/18/2024
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