Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | CA | |
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1336634872 |
---|---|
Provider Name | Valeria Granados |
First Address | El Centro, CA 92243-2302 |
Second Address | El Centro, CA 92243-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 21/11/2019 |