Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 56882 | CA |
Y | 1223P0221X | Pediatric Dentist | 56882 | CA |
NPI | 1073789707 |
---|---|
Provider Name | Paulencia Lajoi Morris |
First Address | Travis Afb, CA 94535-1809 |
Second Address | Travis Afb, CA 94535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2008 |
Last Update Date | 14/08/2019 |