Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | A49421 | CA |
Y | 2080P0214X | Pediatric Pulmonologist | A049421 | CA |
NPI | 1194878512 |
---|---|
Provider Name | Dr. Lauro Yap Roberto |
First Address | Fresno, CA 93720-2457 |
Second Address | Fresno, CA 93720-2457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 17/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A494210 | RENDERING PROVIDER NUMBER (01) | CA |
770208441 | GROUP TAX ID (01) | |
GR0043790 | (05) | CA |
ZZZ21572Z | GROUP PTAN (01) |