Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY 15852 | CA |
NPI | 1154472611 |
---|---|
Provider Name | Carl Gerard Oddo |
First Address | San Francisco, CA 94122-3631 |
Second Address | Walnut Creek, CA 94596-5294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 03/01/2022 |