| NPI | 1700589900 |
|---|---|
| Former Legal Business Name | PRIVATE PRACTICE |
| Entity Type | Organization |
| Authorized Contact | PATRICIA TATENCO-LAGUNA CEO 951-227-3730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-06-13 |