Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | A79334 | CA |
NPI | 1114953262 |
---|---|
Provider Name | Dr. Lukasz Iwanczyk |
First Address | Ventura, CA 93003-2809 |
Second Address | Ventura, CA 93003-7672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114953262 | MEDICARE WA79334C (01) | |
H93787 | (02) | CA |