Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003363755 |
---|---|
Provider Name | Janice Bonello |
First Address | Seaside, CA 93955-6638 |
Second Address | Salinas, CA 93901-2762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 09/09/2016 |