Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 56717 | CA |
NPI | 1003047341 |
---|---|
Provider Name | Dr. Lyla A. Gazarian-Boustani |
First Address | Sherman Oaks, CA 91423-1408 |
Second Address | Glendale, CA 91206-4261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2009 |
Last Update Date | 04/08/2009 |