Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | 162631 | CA |
N | 156FX1800X | Optician | 162631 | CA |
NPI | 1033390943 |
---|---|
Provider Name | Ms. Adriana Laniza Montellano Natividad |
First Address | Torrance, CA 90504-0100 |
Second Address | Torrance, CA 90503-1637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2007 |
Last Update Date | 19/11/2007 |