Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003367004 |
---|---|
Provider Name | Janet Del Real |
First Address | Lynwood, CA 90262-1622 |
Second Address | Lynwood, CA 90262-4284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2016 |
Last Update Date | 14/10/2016 |