Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY15114 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY15114 | CA |
NPI | 1003181967 |
---|---|
Provider Name | Dr. Daura M De Assis |
First Address | Glendale, CA 91202-3215 |
Second Address | Glendale, CA 91202-3215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2012 |
Last Update Date | 12/03/2012 |