| NPI | 1073645586 |
|---|---|
| Doing Business As | CSOC FAST |
| Entity Type | Organization |
| Authorized Contact | AVAMASAG SEMO Medical Records 831-755-4545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2023-09-26 |