Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 4382939 | AZ |
NPI | 1093094484 |
---|---|
Provider Name | Nieves Capri Ortiz Melendez |
First Address | Phoenix, AZ 85027-3636 |
Second Address | Phoenix, AZ 85027-3636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 16/08/2011 |