Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor | MFT49636 | CA |
NPI | 1215186960 |
---|---|
Provider Name | Gladys Dorantes Corado |
First Address | Ontario, CA 91762 |
Second Address | Ontario, CA 91762-2729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2008 |
Last Update Date | 22/03/2013 |