Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 20A 8882 | CA |
NPI | 1033447222 |
---|---|
Provider Name | Dr. Lauren Shirvanee |
First Address | Antioch, CA 94509-6249 |
Second Address | Antioch, CA 94509-6249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2009 |
Last Update Date | 25/11/2009 |