Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 63397 | CA |
NPI | 1003315953 |
---|---|
Provider Name | Elisa Balmori |
First Address | Pomona, CA 91767-2535 |
Second Address | Pomona, CA 91767-2535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2018 |
Last Update Date | 06/02/2018 |