Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 96598 | CA |
NPI | 1003345364 |
---|---|
Provider Name | Ashley Margaret Basualdo |
First Address | San Francisco, CA 94110-3518 |
Second Address | San Francisco, CA 94110-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 09/09/2020 |