Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 36359 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1053601799 |
---|---|
Provider Name | Annielynn Dayao Ibale |
First Address | La Puente, CA 91746-3211 |
Second Address | La Puente, CA 91746-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 17/06/2014 |