Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D6180 | CA |
NPI | 1104041086 |
---|---|
Provider Name | Mrs. Angela Palacios |
First Address | Arleta, CA 91331-6404 |
Second Address | Arleta, CA 91331-6404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 09/07/2007 |