Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 8429 | CA |
NPI | 1003417098 |
---|---|
Provider Name | Mrs. Irma Lizeth Camarena West |
First Address | El Granada, CA 94018-0483 |
Second Address | San Carlos, CA 94070-2317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2020 |
Last Update Date | 05/11/2020 |