Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1104298769 |
---|---|
Provider Name | Zeaunia Green |
First Address | San Diego, CA 92114 |
Second Address | San Diego, CA 92114-3610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2015 |
Last Update Date | 22/10/2015 |