Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY28187 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY28187 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1194855064 |
---|---|
Provider Name | Dr. Grace Mosequera |
First Address | Torrance, CA 90502-1100 |
Second Address | Torrance, CA 90502-1100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/11/2016 |