Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY 23483 | CA |
NPI | 1053484964 |
---|---|
Provider Name | Dr. Cecilia Anne Nepomuceno |
First Address | San Mateo, CA 94403-6281 |
Second Address | Santa Clara, CA 95051-4542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 16/04/2013 |