Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 13353 | NV |
NPI | 1003144858 |
---|---|
Provider Name | Sandra Lipovaca |
First Address | Las Vegas, NV 89146-1217 |
Second Address | North Las Vegas, NV 89030-7143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2009 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13353 | LICENSE (01) | NV |