Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1083026355 |
---|---|
Provider Name | Angelica Porras |
First Address | Oceanside, CA 92056-4565 |
Second Address | Oceanside, CA 92056-4565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 28/05/2014 |