Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G70029 | CA |
NPI | 1053406819 |
---|---|
Provider Name | Ms. Laura Crocitto |
First Address | La Verne, CA 91750-1103 |
Second Address | La Verne, CA 91750-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 17/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G700290 | (05) | CA |
G70439 | (02) |