Most Relevant Information
Provider Data
| NPI Number: | 1003183641 |
| Provider Name: | NICOLE CHAN LISW |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/28/2011 |
| Last Updated: | 03/07/2024 |
Provider Practice Location
11301 WILSHIRE BLVD
LOS ANGELES
CA
900731003
Practice Location Phone/Fax
| Phone: | 3104876026 |
| Fax: |
Provider Mailing Location
11301 WILSHIRE BLVD
LOS ANGELES
CA
900731003
Provider Mailing Phone/Fax
| Phone: | 3104876026 |
| Fax: |