Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 31096 | CA |
NPI | 1003300153 |
---|---|
Provider Name | Dr. Jay Bettergarcia |
First Address | Los Osos, CA 93402-1820 |
Second Address | San Luis Obispo, CA 93407-9000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2018 |
Last Update Date | 24/01/2020 |