Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY15673 | CA |
NPI | 1144355843 |
---|---|
Provider Name | Julie C. Lee-Ancajas |
First Address | Palo Alto, CA 94304-1117 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 24/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY156730 | (05) | CA |
S87664 | (02) | CA |