Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | A72729 | CA |
NPI | 1275571010 |
---|---|
Provider Name | Dr. Jesus Herrera Lao |
First Address | Alpine, CA 91901-3831 |
Second Address | Alpine, CA 91901-3831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 20/02/2017 |