Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1467816447 |
---|---|
Provider Name | Mrs. Renee Lyn Belgarde |
First Address | Fairfield, CA 94533-4719 |
Second Address | Fairfield, CA 94533-4719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 06/04/2016 |