Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A36304 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | A36304 | CA |
NPI | 1144280348 |
---|---|
Provider Name | Danny Lock |
First Address | La Verne, CA 91750-2904 |
Second Address | La Verne, CA 91750-2904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 04/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A28034 | (02) | CA |