Provider Demographics
NPI:1093379430
Name:WESLEY, PRINCESS M
Entity type:Individual
Prefix:MRS
First Name:PRINCESS
Middle Name:M
Last Name:WESLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44734 27TH ST E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2829
Mailing Address - Country:US
Mailing Address - Phone:818-205-8708
Mailing Address - Fax:844-367-9513
Practice Address - Street 1:44734 27TH ST E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-2829
Practice Address - Country:US
Practice Address - Phone:818-205-8708
Practice Address - Fax:844-367-9513
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health