Individual
EBONY STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5190 ATLANTIC AVE, LONG BEACH, CA 90805-6510
(562) 428-4111
Mailing address
2741 E 57TH ST, LONG BEACH, CA 90805-5115
(562) 544-9114
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
281631
CA
Other
Enumeration date
06/09/2016
Last updated
07/27/2016
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