Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY20941 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20941 | CA |
NPI | 1003035452 |
---|---|
Provider Name | Mrs. Vanessa Diane Isetta |
First Address | Hermosa Beach, CA 90254-2753 |
Second Address | Hermosa Beach, CA 90254-2751 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 06/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00007302 | (05) | CA |
CB24537 | LA DMH PROVIDER (01) | CA |