Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LAC-17659 | AZ |
NPI | 1003386855 |
---|---|
Provider Name | Sabrina Landa |
First Address | Laveen, AZ 85339-2952 |
Second Address | Mesa, AZ 85202-5662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2018 |
Last Update Date | 04/12/2018 |