Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1043705692 |
---|---|
Provider Name | Salma Sofia Amparan Marquez |
First Address | Pomona, CA 91767-2722 |
Second Address | Pomona, CA 91767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 25/09/2019 |