Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC21626 | CA |
NPI | 1821106360 |
---|---|
Provider Name | Dr. Lisa Ann Camerino |
First Address | Hayward, CA 94541-3020 |
Second Address | Hayward, CA 94541-3020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U50842 | (02) | CA |