Pearl A Lake Valid NPI
Individual provider · Military Health Care Provider · Philadelphia, PA
- NPI
- 1053907261
- Type
- Individual (Type 1)
- Primary specialty
- Military Health Care Provider
- Specialty group
- Other Service Providers
- Taxonomy code
- 171000000X
- License number
- 7000.000000634RMA (PA)
- Sex
- Female
- Sole proprietor
- Yes
- Enumerated
- 2020-12-12
- Last updated
- 2020-12-12
Practice location
2214 S 57th St
Philadelphia, PA 19143-5705
(886) 884-8807