Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 42517 | CA |
NPI | 1003569955 |
---|---|
Provider Name | Ganiece Gaubatz |
First Address | Woonsocket, RI 02895 |
Second Address | Irvine, CA 92602-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |