Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY7974 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY7974 | CA |
NPI | 1003801457 |
---|---|
Provider Name | F Victoria Dicicco |
First Address | San Diego, CA 92122 |
Second Address | San Diego, CA 92122-2847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY079740 | (05) | CA |
R62254 | (02) |