Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP95000040 | CA |
NPI | 1003246315 |
---|---|
Provider Name | Luamy Gabriela Cornejo |
First Address | Loma Linda, CA 92354-2811 |
Second Address | Riverside, CA 92501-4026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2013 |
Last Update Date | 22/11/2013 |