Individual
GIANNI SAMANTHA CORILLA-LAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3102 E HIGHLAND AVE, PATTON, CA 92369-7813
(909) 425-7000
Mailing address
16624 SUGAR LN, FONTANA, CA 92337-7626
(909) 232-6186
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95345000
CA
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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