| NPI | 1306407473 |
|---|---|
| Former Name | GENESIS VASCONEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95015640) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 95185269) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-06-27 |