Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 1093 | AZ |
NPI | 1700949906 |
---|---|
Provider Name | Iris Pearlman |
First Address | Tucson, AZ 95706 |
Second Address | Tucson, AZ 85706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
615990 | (05) | AZ |