Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LEP3731 | CA |
Y | 103T00000X | Psychologist | LEP3731 | CA |
NPI | 1003446766 |
---|---|
Provider Name | Jennifer Bopp Litz |
First Address | Fresno, CA 93721-2002 |
Second Address | Fresno, CA 93728-2518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2020 |
Last Update Date | 22/01/2020 |