Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 33541 | CA |
NPI | 1003915810 |
---|---|
Provider Name | Dr. Lisa Michelle Angelici |
First Address | Huntington Beach, CA 92647-7042 |
Second Address | Huntington Beach, CA 92647-7042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |