Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 617437 | CA |
NPI | 1053834226 |
---|---|
Provider Name | Carolyn Lycurgus Breuer |
First Address | Lancaster, CA 93535-1916 |
Second Address | Lancaster, CA 93535-1916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2017 |
Last Update Date | 19/07/2017 |