Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A137757 | CA |
N | 111NI0900X | Internist | A137757 | CA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A137757 | CA |
NPI | 1043638711 |
---|---|
Provider Name | Laura Sue |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90015-3068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 03/10/2019 |