Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY31003 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY31003 | CA |
NPI | 1003453853 |
---|---|
Provider Name | Paul Santero |
First Address | La Mesa, CA 91942-9118 |
Second Address | La Jolla, CA 92037-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2019 |
Last Update Date | 27/11/2019 |