Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 523 | CA |
NPI | 1083125652 |
---|---|
Provider Name | Ms. Katrina Megan Lertola |
First Address | Carlsbad, CA 92008-1545 |
Second Address | Carlsbad, CA 92008-1545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2017 |
Last Update Date | 02/04/2018 |