Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY11927 | CA |
N | 103T00000X | Psychologist | PSY11927 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY11927 | CA |
NPI | 1386653418 |
---|---|
Provider Name | Sylvia Boris |
First Address | Sepulveda, CA 90064 |
Second Address | Sepulveda, CA 90064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |