Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | MFC44200 | CA |
NPI | 1003049560 |
---|---|
Provider Name | Mr. Keith David Attardo |
First Address | Los Alamitos, CA 90720-3493 |
Second Address | Los Alamitos, CA 90720-3493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 01/09/2009 |