Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 06287 | MD |
NPI | 1649765918 |
---|---|
Provider Name | Mayra Lizeth Sanchez Gonzalez |
First Address | Baltimore, MD 21287 |
Second Address | Baltimore, MD 21287-0010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 08/11/2019 |