Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1184758880 |
---|---|
Provider Name | Shelly Baesler |
First Address | Pomona, CA 91768-2054 |
Second Address | Pomona, CA 91768-2054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 15/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C013520 | LADMH STAFF CODE (01) | CA |
ICAN670 | DMH STAFF CODE (01) | CA |