Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LCI04320815 | CA |
NPI | 1144736000 |
---|---|
Provider Name | Dr. James Lee Profit |
First Address | San Diego, CA 92108-3543 |
Second Address | San Diego, CA 92108-3543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2017 |
Last Update Date | 14/12/2017 |