Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | AII054080418 | CA |
NPI | 1003373002 |
---|---|
Provider Name | Raul Franco |
First Address | Chula Vista, CA 91910-1124 |
Second Address | Chula Vista, CA 91910-1124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2019 |
Last Update Date | 26/02/2019 |