Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS 21503 | CA |
NPI | 1003063512 |
---|---|
Provider Name | Ms. Sandra Maura |
First Address | Santa Cruz, CA 95060-3020 |
Second Address | Santa Cruz, CA 95060-3020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 27/08/2008 |