Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 13947 | CA |
NPI | 1083059653 |
---|---|
Provider Name | Jocelyn Mao Fisher |
First Address | Irvine, CA 92602 |
Second Address | Santa Fe Springs, CA 90670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 17/01/2014 |