Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003344771 |
---|---|
Provider Name | Martha Nunez |
First Address | Ontario, CA 91764-4898 |
Second Address | San Bernardino, CA 92408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2017 |
Last Update Date | 29/06/2021 |