Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | A156691 | CA |
Y | 208000000X | Pediatrician | A156691 | CA |
NPI | 1255728317 |
---|---|
Provider Name | Lucille Uber |
First Address | Los Angeles, CA 90010-2814 |
Second Address | Los Angeles, CA 90033-2414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 14/07/2020 |