| NPI | 1053859579 |
|---|---|
| Former Name | LAURA MEDINA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110611) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW80697) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2023-06-15 |