Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY13413 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY13413 | CA |
NPI | 1003824103 |
---|---|
Provider Name | Dr. Rigoverto Cabrera Briceno |
First Address | Lynwood, CA 90262-3513 |
Second Address | Lynwood, CA 90262-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY134130 | (05) | CA |