Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 103TS0200X | CA |
NPI | 1083162689 |
---|---|
Provider Name | Lilia Carreon Willis |
First Address | La Verne, CA 91750-5416 |
Second Address | La Verne, CA 91750-5416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2016 |
Last Update Date | 13/09/2016 |