Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2230 | CA |
NPI | 1043560436 |
---|---|
Provider Name | Luisa Bottari |
First Address | Los Angeles, CA 90069 |
Second Address | Los Angeles, CA 90069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 13/09/2012 |