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1205124039
LAVALLE DEPRICE BULLARD
MORENO VALLEY, CA
NPI
1205124039
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Other Name
OMAR CAMARA MUHAMMAD
Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2011-07-13
Last Update Date
2012-05-16
Business Address
-- LAVALLE DEPRICE BULLARD
13800 HEACOCK ST SUITE C236
MORENO VALLEY, CA 92553-3339
Phone number: 951-653-0819
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Mailing Address
-- LAVALLE DEPRICE BULLARD
22058 GOLDENCHAIN ST
MORENO VALLEY, CA 92553-6955
Phone number: 909-720-2699
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