NPI | 1013332725 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK JEFFREY VIGIL DOMBECK President 510-900-5123 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25695) |
Enumeration Date | 2014-03-04 |
Last Update Date | 2017-11-19 |