MISS Elise La Keisha Wallace, 172V00000X
NPI #1376079558 in Compton, California
Provider Information
- NPI Number
- 1376079558
- Entity Type
- Individual
- Name
- MISS Elise La Keisha Wallace, 172V00000X
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Community Health Worker
- Credential
- 172V00000X
- Enumeration Date
- May 5, 2017
- Last Updated
- May 5, 2017
Practice Location
- Address
- 921 E COMPTON BLVD
- City
- Compton
- State
- California
- ZIP Code
- 90221-3303
- Phone
- (310) 668-6947
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Health Worker |
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