| 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 |