Individual
BERNITA LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
474 W VERNONT AVENUE, ESCONDIDO, CA 92025-6584
(760) 432-9884
Mailing address
474 W VERMONT AVE, ESCONDIDO, CA 92025-6584
(760) 432-9884
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/20/2010
Last updated
01/20/2010
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