Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | AMFT109225 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043786502 |
---|---|
Provider Name | Ivonne Thelma Campuzano |
First Address | Pasadena, CA 91105-4025 |
Second Address | Pasadena, CA 91105-4025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2018 |
Last Update Date | 14/01/2021 |