Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A121140 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | A121140 | CA |
NPI | 1013209568 |
---|---|
Provider Name | Lorraine Anderson |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-1265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2011 |
Last Update Date | 03/01/2020 |