Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY21886 | CA |
Y | 103T00000X | Psychologist | PSY21886 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1033254420 |
---|---|
Provider Name | Dr. Georgina Moncho |
First Address | Pasadena, CA 91101-1710 |
Second Address | Pasadena, CA 91101-1710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 11/12/2012 |