Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E5372 | CA |
N | 222Z00000X | Podiatrist | E5372 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E5372 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E5372 | CA |
NPI | 1205242765 |
---|---|
Provider Name | Lisa Doan Breshears |
First Address | Upland, CA 91786-3854 |
Second Address | Upland, CA 91786-3854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2014 |
Last Update Date | 26/07/2017 |