Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 61321 | CA |
NPI | 1003209826 |
---|---|
Provider Name | Mariana Gumm |
First Address | Livingston, CA 95334-1257 |
Second Address | Livingston, CA 95334-1257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2015 |
Last Update Date | 18/03/2015 |