Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1093830770 |
---|---|
Provider Name | Dr. Martha Acosta Rios |
First Address | Glendale, CA 91203-1314 |
Second Address | Los Angeles, CA 90095-7142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |