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Organization
SELENA ANNE LANTRY, M.D., INC
Active
Organization
SELENA ANNE LANTRY, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SELENA ANNE LANTRY (PRESIDENT)
(818) 247-2164
Entity
Organization
Contact information
Practice address
1505 WILSON TER STE 130, GLENDALE, CA 91206-4074
(818) 247-2164
Mailing address
1505 WILSON TER STE 130, GLENDALE, CA 91206-4074
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G55968
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G559681
—
CA
Enumeration date
12/07/2010
Last updated
12/07/2010
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