Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G064878 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G064878 | CA |
N | 207ND0900X | Dermatopathologist | G064878 | CA |
N | 207NS0135X | Procedural Dermatology | G064878 | CA |
NPI | 1639112147 |
---|---|
Provider Name | Dr. Robert H Lesnik |
First Address | Palm Desert, CA 92260-4135 |
Second Address | Palm Desert, CA 92260-4135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 20/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E35895 | (02) | |
G064878 | STATE MEDICAL LICENSE (01) | CA |