Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003104068 |
---|---|
Provider Name | Miss Lolita Patricia Xuncax |
First Address | Sacramento, CA 95832-1203 |
Second Address | Sacramento, CA 95823-2006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 12/07/2011 |