Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XM0800X | Mental Health |
NPI | 1942775069 |
---|---|
Provider Name | Nelson Antonio Bohorquez |
First Address | Los Angeles, CA 90042-4883 |
Second Address | Los Angeles, CA 90042-4883 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2018 |
Last Update Date | 04/10/2018 |