Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | C53095 | CA |
NPI | 1114196003 |
---|---|
Provider Name | Joan Elizabeth Lipa |
First Address | Los Angeles, CA 90045-5632 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2008 |
Last Update Date | 11/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G530950 | (05) | CA |