Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A75621 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A75621 | CA |
N | 207ND0900X | Dermatopathologist | A75621 | CA |
N | 207NS0135X | Procedural Dermatology | A75621 | CA |
NPI | 1285769182 |
---|---|
Provider Name | Jacob E Lau |
First Address | Oxnard, CA 93036-2213 |
Second Address | Oxnard, CA 93036-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 24/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A756210 | MEDI-CAL (01) | |
H95740 | (02) | CA |