Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY17723 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY17723 | CA |
NPI | 1013095629 |
---|---|
Provider Name | Dr. Marylouise None Barros-Niska |
First Address | San Pedro, CA 90731 |
Second Address | Rolling Hills Estates, CA 90274-7612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/03/2016 |