Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A93366 | CA |
NPI | 1134271067 |
---|---|
Provider Name | Olga Lyass |
First Address | Simi Valley, CA 93062-0190 |
Second Address | Lancaster, CA 93534-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 16/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A933660 | (05) | CA |
I69490 | (02) |