Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 41733 | CA |
NPI | 1073643771 |
---|---|
Provider Name | Ingrid Lawaty |
First Address | Santa Barbara, CA 93103-4236 |
Second Address | Santa Barbara, CA 93103-4236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 07/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77-0545644 | TAX I D (01) | CA |