Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY32702 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY32702 | CA |
NPI | 1003336868 |
---|---|
Provider Name | Mr. Paul Kiritsis |
First Address | San Ramon, CA 94583-4409 |
Second Address | San Ramon, CA 94583-4409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2017 |
Last Update Date | 13/10/2021 |