Individual
LAMAR RAY NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10478 THORNDALE ST, ADELANTO, CA 92301-4887
(909) 730-5136
Mailing address
10478 THORNDALE ST, ADELANTO, CA 92301-4887
(909) 730-5136
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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