NPI | 1518412345 |
---|---|
Former Name | ALEXA DIAMOND BOUBALOS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95009707) |
Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: CA 95104937) |
Enumeration Date | 2016-08-22 |
Last Update Date | 2020-09-16 |