Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003317488 |
---|---|
Provider Name | Cameron Sidney |
First Address | Pomona, CA 91767-3802 |
Second Address | Pomona, CA 91767-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 22/02/2018 |