Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 103117 | CA |
NPI | 1003434598 |
---|---|
Provider Name | Mrs. Marily Velasco |
First Address | Sacramento, CA 95823-7076 |
Second Address | Sacramento, CA 95823-7076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2020 |
Last Update Date | 20/08/2021 |