Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1053778126 |
---|---|
Provider Name | Nicholas John-Carlos Inguillo |
First Address | San Jose, CA 95124-1537 |
Second Address | San Jose, CA 95124-1537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2016 |
Last Update Date | 02/03/2016 |