Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 6828 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 6828 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 6828 | CA |
NPI | 1063646271 |
---|---|
Provider Name | Dr. Denise Luria |
First Address | Los Angeles, CA 90049-5075 |
Second Address | Los Angeles, CA 90049-5075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2009 |
Last Update Date | 04/05/2009 |