Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | KK592911 | CA |
NPI | 1366908741 |
---|---|
Provider Name | Alicia Lander |
First Address | Oakland, CA 94601-5438 |
Second Address | Oakland, CA 94601-5438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2019 |
Last Update Date | 11/02/2019 |