Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 44396 | CA |
NPI | 1003131491 |
---|---|
Provider Name | Dr. Doreece Elihu |
First Address | Los Angeles, CA 90035-1148 |
Second Address | Los Angeles, CA 90035-1148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2010 |
Last Update Date | 14/01/2011 |