Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | EL6760 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | EL6760 | CA |
NPI | 1356726335 |
---|---|
Provider Name | Dr. Lateef Olasunkanmi Lawal JR. |
First Address | Palo Alto, CA 94304-1207 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2015 |
Last Update Date | 20/07/2015 |