Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | CA |
NPI | 1174147888 |
---|---|
Provider Name | Mr. Ever Anselmo Mesa |
First Address | Sacramento, CA 95818-9033 |
Second Address | Sacramento, CA 95833-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2020 |
Last Update Date | 29/05/2020 |