| NPI | 1730589391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH P REVETTO Owner/Manger/Provider 909-556-3939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 16033) |
| Enumeration Date | 2014-09-01 |
| Last Update Date | 2020-01-09 |