Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 87477 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023325925 |
---|---|
Provider Name | Jessica Roosinisalda-Gomez |
First Address | Huntington Park, CA 90255-6141 |
Second Address | Huntington Park, CA 90255-6141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 11/05/2020 |