Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 40409 | CA |
Y | 213EG0000X | General Practice | 40409 | CA |
NPI | 1003917345 |
---|---|
Provider Name | Ms. Ma. Loida Serrano Leyba |
First Address | Elk Grove, CA 95624-3301 |
Second Address | Elk Grove, CA 95624-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |