Individual
LOLA SHARAPOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1127 S 38TH ST, SAN DIEGO, CA 92113-3210
(619) 262-4002
Mailing address
1127 S 38TH ST, SAN DIEGO, CA 92113-3210
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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