Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1538397849 |
---|---|
Provider Name | Ms. Laura Prengaman |
First Address | Huntington Beach, CA 92646-2260 |
Second Address | Huntington Beach, CA 92646-2260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 25/06/2009 |