Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 49350 | CA |
NPI | 1659461721 |
---|---|
Provider Name | Dr. Peter A Krakowiak |
First Address | Lake Elsinore, CA 92530-4400 |
Second Address | Lake Elsinore, CA 92530-4400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |