Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 28544 | CA |
NPI | 1003157389 |
---|---|
Provider Name | Mr. Javier Perez |
First Address | San Diego, CA 92116-4113 |
Second Address | San Diego, CA 92116-4113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2013 |
Last Update Date | 11/03/2013 |