Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 62304 | CA |
NPI | 1033553961 |
---|---|
Provider Name | Dr. Megan Leraye Lecornu |
First Address | Santa Clarita, CA 91321-2672 |
Second Address | Santa Clarita, CA 91321-2672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 15/05/2014 |