Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003452327 |
---|---|
Provider Name | Georgina Lisa Sanchez |
First Address | Bloomington, CA 92316-2636 |
Second Address | Bloomington, CA 92316-2636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2019 |
Last Update Date | 21/11/2019 |