Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | VN 128576 | CA |
N | 101YP1600X | Pastoral Counselor | CA |
NPI | 1164777421 |
---|---|
Provider Name | Elise Zamudio |
First Address | Pasadena, CA 91105-3214 |
Second Address | Pasadena, CA 91105-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 03/05/2013 |