Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS 12740 | CA |
NPI | 1003146580 |
---|---|
Provider Name | Oi Wan Alia Man |
First Address | Los Angeles, CA 90017-1209 |
Second Address | Los Angeles, CA 90017-1204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 17/02/2021 |