Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY22819 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY22819 | CA |
N | 102L00000X | Psychologist | PSY22819 | CA |
N | 103T00000X | Psychologist | PSY22819 | CA |
NPI | 1013148469 |
---|---|
Provider Name | Maria Jose Prieto De Estebecorena |
First Address | San Rafael, CA 94901-2694 |
Second Address | San Rafael, CA 94901-2694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2009 |
Last Update Date | 14/03/2011 |