Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | CA |
NPI | 1003298951 |
---|---|
Provider Name | Ana R Dolores |
First Address | Madera, CA 93638-3978 |
Second Address | Sacramento, CA 95826-2592 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 26/06/2015 |