Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A123624 | CA |
Y | 2080P0210X | Pediatric Nephrologist | A123624 | CA |
NPI | 1700127792 |
---|---|
Provider Name | Mrs. Marciana Lee Laster |
First Address | Los Angeles, CA 90095-1752 |
Second Address | Los Angeles, CA 90095-1432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2013 |
Last Update Date | 03/06/2019 |