Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | T08231 | CA |
NPI | 1003956731 |
---|---|
Provider Name | Dr. Lisa M Galstian |
First Address | La Jolla, CA 92037-7105 |
Second Address | San Diego, CA 92122-1937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0082310 | (05) | CA |
T70258 | (02) | CA |