Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY 005253 | FL |
Y | 103T00000X | Psychologist | PY 005253 | FL |
NPI | 1003832262 |
---|---|
Provider Name | Ms. Lourdes Pola |
First Address | Hialeah, FL 33016-3946 |
Second Address | Hialeah, FL 33016-3946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |