Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | G57989 | CA |
Y | 207VX0201X | Gynecologic Oncologist | G57989 | CA |
NPI | 1306841648 |
---|---|
Provider Name | Laila I Muderspach |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 09/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E28285 | (02) | CA |