Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1043731474 |
---|---|
Provider Name | Mr. Dakari Quimby |
First Address | Los Angeles, CA 90027-6062 |
Second Address | Los Angeles, CA 90027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2017 |
Last Update Date | 03/07/2018 |