Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043406713 |
---|---|
Provider Name | Umaru Fofana |
First Address | San Jose, CA 95131-1888 |
Second Address | San Jose, CA 95131-1888 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2007 |
Last Update Date | 17/02/2021 |