Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003083221 |
---|---|
Provider Name | Mariaelena Garcia Vasquez |
First Address | Stockton, CA 95202-1305 |
Second Address | Stockton, CA 95202-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 15/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S0081192 | DRIVER LICENSE (01) | CA |