Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DDS103406 | CA |
NPI | 1063057008 |
---|---|
Provider Name | Dr. Robert Lacrampe |
First Address | Danville, CA 94526-1545 |
Second Address | Los Angeles, CA 90012-2473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 13/11/2019 |