Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | DC 27804 | CA |
NPI | 1417092677 |
---|---|
Provider Name | Mr. Michael Lane Lipsky |
First Address | Thousand Oaks, CA 91362 |
Second Address | Thousand Oaks, CA 91362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 23/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC 27804 | LICENSE # (01) | CA |