Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 20089 | NV |
N | 208D00000X | General Practice Physician | 278253 | NY |
NPI | 1316380389 |
---|---|
Provider Name | Lisa M Angotti |
First Address | Las Vegas, NV 89102-1973 |
Second Address | Las Vegas, NV 89102-2354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2013 |
Last Update Date | 24/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20089 | MEDICAL LICENSE (01) | NV |