Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 15111 | CA |
Y | 103T00000X | Psychologist | 15111 | CA |
NPI | 1003439381 |
---|---|
Provider Name | Rosa Maria Colonna |
First Address | Los Angeles, CA 90045-2079 |
Second Address | Long Beach, CA 90807-2617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2020 |
Last Update Date | 21/05/2020 |