Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | G78873 | CA |
NPI | 1053499897 |
---|---|
Provider Name | Dee Anne Lacy |
First Address | Oakland, CA 94612-3466 |
Second Address | Fresno, CA 93720-2941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G788730 | (05) | CA |
H30125 | (02) |