Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 36802 | TX |
NPI | 1235738527 |
---|---|
Provider Name | Lorena Malpica |
First Address | San Antonio, TX 78249-3093 |
Second Address | San Antonio, TX 78249-3093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2020 |
Last Update Date | 19/10/2020 |