Individual
BETTY ANN WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1865 W. 9TH STREET, SANTA MONICA, CA 90405
(323) 947-3680
Mailing address
2644 30TH ST STE 100, SANTA MONICA, CA 90405-3051
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/10/2019
Last updated
10/30/2019
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