Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS26613 | CA |
NPI | 1003234436 |
---|---|
Provider Name | Esmeralda Briseno |
First Address | Laguna Hills, CA 92653-1547 |
Second Address | Laguna Hills, CA 92653-1547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 02/04/2014 |