Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003371741 |
---|---|
Provider Name | Virgil Gaba Bagaoisan |
First Address | Oakland, CA 94609-2633 |
Second Address | Oakland, CA 94609-2633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |