Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY24686 | CA |
Y | 103T00000X | Psychologist | PSY24686 | CA |
N | 103G00000X | Clinical Psychologist | PSY24686 | CA |
N | 103TC0700X | Clinical Psychologist | PSY24686 | CA |
NPI | 1003949512 |
---|---|
Provider Name | Irma K Ocegueda-Arjona |
First Address | Pico Rivera, CA 90660-1409 |
Second Address | Los Angeles, CA 90026-4915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 04/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHMC119 | STAFF CODE (01) | CA |