Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G54388 | CA |
NPI | 1023039815 |
---|---|
Provider Name | Dr. Hayward Lynn Eubanks |
First Address | Hawthorne, CA 90250-2255 |
Second Address | Los Angeles, CA 90043-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 27/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A93297 | (02) | CA |