Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G58945 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G58945 | CA |
N | 207ND0900X | Dermatopathologist | G58945 | CA |
N | 207NS0135X | Procedural Dermatology | G58945 | CA |
NPI | 1508852799 |
---|---|
Provider Name | Lorrie J Klein |
First Address | Laguna Niguel, CA 92677-5979 |
Second Address | Laguna Niguel, CA 92677-5979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 28/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E33326 | (02) | CA |