Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1013311349 |
---|---|
Provider Name | Rajendra Kewallal |
First Address | Visalia, CA 93277 |
Second Address | Visalia, CA 93277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2014 |
Last Update Date | 15/10/2014 |