Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | A113545 | CA |
NPI | 1811284219 |
---|---|
Provider Name | Dr. Iris Jolly Joanna Castillo Mencias |
First Address | Torrance, CA 90503-5501 |
Second Address | Torrance, CA 90503-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 23/04/2012 |