Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | PSY 20028 | CA |
NPI | 1508922006 |
---|---|
Provider Name | Dr. Jessica M Del Pozo |
First Address | Roseville, CA 95678-5134 |
Second Address | Roseville, CA 95678-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |