Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003170903 |
---|---|
Provider Name | Jose De Jesus Eulloqui |
First Address | Santa Maria, CA 93455-6415 |
Second Address | San Luis Obispo, CA 93401-8750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 21/05/2015 |