Provider Information for 1134433394
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KILA THERESE DAMES
Sex: Female
NPI: 1134433394
Last Updated: 2022-03-01
Certification Date: 2022-03-01
Certification Date: 2022-03-01
Details
Name | Value | ||||||||||||||||
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NPI | 1134433394 | ||||||||||||||||
Enumeration Date | 2010-07-29 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 2640 INDUSTRY WAY LYNWOOD, CA 90262-4284 United States Phone: 310-221-6336 | Fax: | ||||||||||||||||
Primary Practice Address | 2640 INDUSTRY WAY LYNWOOD, CA 90262-4284 United States Phone: 310-221-6336 | Fax: | ||||||||||||||||
Secondary Practice Address(es) | 901 N PACIFIC COAST HWY 1501 HUGHES WAY STE 150 | ||||||||||||||||
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