Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY005556 | FL |
Y | 103T00000X | Psychologist | PY005556 | FL |
NPI | 1003861097 |
---|---|
Provider Name | Daima Pico-Guardado |
First Address | Miami, FL 33137-2706 |
Second Address | Miami, FL 33137-2706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 03/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54139 | BLUE CROSS BLUE SHIELD (01) | FL |