Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 63572 | CA |
NPI | 1003235169 |
---|---|
Provider Name | Dr. Luiza Portnoff |
First Address | Lancaster, CA 93534-2831 |
Second Address | Lancaster, CA 93534-2831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 24/04/2019 |