| NPI | 1689102568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE AGUILAR Credentialing Account Manager 210-714-9823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-23 |