Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 22029 | CA |
NPI | 1215184973 |
---|---|
Provider Name | Nancy Farrell |
First Address | Pomona, CA 91767-1923 |
Second Address | Pomona, CA 91767-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2008 |
Last Update Date | 25/08/2008 |