Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 25MA03941500 | NJ |
Y | 207VX0201X | Gynecologic Oncologist | C162435 | CA |
NPI | 1457436719 |
---|---|
Provider Name | Lorna Rodriguez |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8146705 | (05) | NJ |
A64149 | (02) | NJ |