Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC25091 | CA |
NPI | 1619099108 |
---|---|
Provider Name | Dr. Lisa Karen Polevoy |
First Address | Berkeley, CA 94710-1929 |
Second Address | Berkeley, CA 94710-1929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |