Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 34469 | CA |
NPI | 1154889772 |
---|---|
Provider Name | Keola Lorenzo |
First Address | Whittier, CA 90602-2341 |
Second Address | Long Beach, CA 90815-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 14/06/2019 |