Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY29282 | CA |
Y | 103T00000X | Psychologist | PSY29282 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 29282 | CA |
NPI | 1033631320 |
---|---|
Provider Name | Dr. Natalie Poursohrab Wager |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2017 |
Last Update Date | 17/03/2018 |