Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1083198352 |
---|---|
Provider Name | Mr. Jose Carlos Sandoval |
First Address | Chico, CA 95926-5127 |
Second Address | Chico, CA 95926-2460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2018 |
Last Update Date | 21/09/2018 |