Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1386174803 |
---|---|
Provider Name | Lynne Bernadette Hebron Eduvala |
First Address | Hayward, CA 94545-1343 |
Second Address | San Jose, CA 95126-1136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 18/06/2017 |