Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 17280 | CA |
Y | 103T00000X | Psychologist | 17280 | CA |
NPI | 1013014992 |
---|---|
Provider Name | Kami Elizabeth Bryant |
First Address | Indio, CA 92201-6950 |
Second Address | Indio, CA 92201-6950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OPL172800 | (02) | CA |