Individual
LISA ANN WATERS AYERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2306 CHRISTI AVE, IMPERIAL, CA 92251-8834
(443) 497-9890
Mailing address
2306 CHRISTI AVE, IMPERIAL, CA 92251-8834
(443) 497-9890
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y4769542
DRIVER LICENSE
CA
Enumeration date
09/24/2019
Last updated
09/24/2019
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