Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003201575 |
---|---|
Provider Name | Marisa Romero |
First Address | Clovis, CA 93612-4249 |
Second Address | Fresno, CA 93703-1425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2015 |
Last Update Date | 06/11/2015 |