Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY19997 | CA |
Y | 103T00000X | Psychologist | PSY19997 | CA |
NPI | 1003852120 |
---|---|
Provider Name | Dr. Annette Marie Conway |
First Address | San Diego, CA 92130-1325 |
Second Address | San Diego, CA 92103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |