Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | PT41284 | CA |
NPI | 1124623327 |
---|---|
Provider Name | Irene Mayorga |
First Address | Rosemead, CA 91770-3321 |
Second Address | Rosemead, CA 91770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2020 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT41284 | PSYCHIATRIC TECHNICIAN (01) | CA |