Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY30925 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY30925 | CA |
N | 103TH0004X | Health Psychologist | PSY30925 | CA |
NPI | 1629691126 |
---|---|
Provider Name | Rika Tanaka |
First Address | Coronado, CA 92178-2208 |
Second Address | Coronado, CA 92118-2646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 19/05/2020 |