Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 150944 | NY |
NPI | 1083737399 |
---|---|
Provider Name | Mrs. Lyla Janeil Correoso Thomas |
First Address | Rosemont, IL 60018-4989 |
Second Address | Columbia, MD 21045-3263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 11/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D91711 | (02) | |
D91711 | (02) | NY |