Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 059183 | NY |
Y | 1223E0200X | Endodontist | 101937 | CA |
NPI | 1144672270 |
---|---|
Provider Name | Dr. Leiza Yamila Walia |
First Address | Glendale, CA 91205-5077 |
Second Address | Tustin, CA 92782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 08/10/2019 |