Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 103TS0200X | School Psychologist |
NPI | 1053590968 |
---|---|
Provider Name | Erica Segundo |
First Address | San Bernardino, CA 92408-3328 |
Second Address | San Bernardino, CA 92408-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 29/04/2008 |