Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY15801 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY15801 | CA |
NPI | 1003841636 |
---|---|
Provider Name | Joyce Sese Dorado |
First Address | San Francisco, CA 94120-7464 |
Second Address | San Francisco, CA 94110-3518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S72156 | (02) |