Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1306219050 |
---|---|
Provider Name | Michael Cloud SR. |
First Address | San Diego, CA 92105-5414 |
Second Address | San Diego, CA 92105-5414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2015 |
Last Update Date | 03/11/2015 |