Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8756 | CA |
NPI | 1013079748 |
---|---|
Provider Name | Dr. Cecilia Kavanagh |
First Address | La Jolla, CA 92037-5975 |
Second Address | Carlsbad, CA 92011-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2006 |
Last Update Date | 08/07/2007 |