Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 102641 | CA |
Y | 213EG0000X | General Practice | 102641 | CA |
NPI | 1003302969 |
---|---|
Provider Name | Dr. Janet Lillian Pezold |
First Address | Corona, CA 92879-7992 |
Second Address | Eastvale, CA 92880-7257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2018 |
Last Update Date | 03/07/2018 |