Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A145699 | CA |
N | 208D00000X | General Practice Physician | A145699 | CA |
NPI | 1235424771 |
---|---|
Provider Name | Maria Luz Lara-Marquez |
First Address | San Diego, CA 92123-1870 |
Second Address | San Diego, CA 92123-1870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 01/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235424771 | NPI (01) | CA |