Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY6292 | CA |
NPI | 1053686428 |
---|---|
Provider Name | Dr. Sandra Ann Pursell |
First Address | Menlo Park, CA 94025-5339 |
Second Address | Menlo Park, CA 94025-5339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2012 |
Last Update Date | 18/03/2012 |