Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 29929 | CA |
N | 103T00000X | Psychologist | 29929 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 29929 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | 29929 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 29929 | CA |
Y | 103G00000X | Clinical Psychologist | 29929 | CA |
Y | 103TC0700X | Clinical Psychologist | 29929 | CA |
N | 103TC1900X | Counseling Psychologist | 29929 | CA |
N | 103TF0000X | Family Psychologist | 29929 | CA |
N | 103TH0004X | Health Psychologist | 29929 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 29929 | CA |
N | 103TP2701X | Group Psychotherapist | 29929 | CA |
NPI | 1396099438 |
---|---|
Provider Name | Dr. Marivi Acuna |
First Address | Los Angeles, CA 91604-9998 |
Second Address | Lake Balboa, CA 91406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2012 |
Last Update Date | 13/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01261511 | (05) | CA |