Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003161456 |
---|---|
Provider Name | Guadalupe Javier-Diaz |
First Address | Marina, CA 93933-2865 |
Second Address | Monterey, CA 93940-3974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2012 |
Last Update Date | 20/07/2012 |