Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor |
NPI | 1003322462 |
---|---|
Provider Name | Serenity Marie Elias-Vasquez |
First Address | San Jose, CA 95126-3797 |
Second Address | San Jose, CA 95131-3585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2017 |
Last Update Date | 21/12/2017 |