Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist |
NPI | 1578030953 |
---|---|
Provider Name | Edmon Artinyan |
First Address | Oakland, CA 94606-1329 |
Second Address | Manteca, CA 95337-5130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 24/10/2018 |