Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP441 | CA |
NPI | 1043559933 |
---|---|
Provider Name | Mrs. Lucy Halbasch |
First Address | Norwalk, CA 90650-4022 |
Second Address | Norwalk, CA 90650-4022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2013 |
Last Update Date | 12/02/2013 |