Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 22445 | CA |
Y | 124Q00000X | Dental Hygienist | 310 | CA |
NPI | 1063783512 |
---|---|
Provider Name | Christy Lorson |
First Address | San Marcos, CA 92069-1304 |
Second Address | San Marcos, CA 92069-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2012 |
Last Update Date | 14/01/2012 |