Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 26917 | CA |
Y | 103T00000X | Psychologist | 26917 | CA |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1093049918 |
---|---|
Provider Name | Dr. Yvonne Burgos |
First Address | Ontario, CA 91762-0025 |
Second Address | La Verne, CA 91750-1146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2009 |
Last Update Date | 05/08/2021 |