Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2989 | CA |
NPI | 1073096970 |
---|---|
Provider Name | Jessica Ocoboc Houston |
First Address | Anaheim, CA 92805-5749 |
Second Address | Anaheim, CA 92805-5749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |