Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A113285 | CA |
NPI | 1003050667 |
---|---|
Provider Name | Dr. Lisa Marie Sprowl |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Sacramento, CA 95834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 28/09/2012 |