Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 27039 | CA |
NPI | 1093102964 |
---|---|
Provider Name | Dr. Rodolfo Victoria |
First Address | Huntington Pk, CA 90255-3231 |
Second Address | Los Angeles, CA 90017-2457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2015 |
Last Update Date | 18/04/2015 |