Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003219718 |
---|---|
Provider Name | Ryan Atendido |
First Address | Fresno, CA 93720-2986 |
Second Address | Fresno, CA 93720-2986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 26/07/2015 |