Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | LEP1822 | CA |
NPI | 1023593696 |
---|---|
Provider Name | Diana Zelezny |
First Address | Glendale, CA 91202-1610 |
Second Address | Whittier, CA 90602-1123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2018 |
Last Update Date | 30/09/2018 |