NPI | 1790098978 |
---|---|
Entity Type | Organization |
Authorized Contact | DIRK DE BRITO President 310-717-0069 |
Organization Subpart ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA A66604) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA PSY26446) |
302F00000X Exclusive Provider Organization (Licence: CA G64523) | |
Enumeration Date | 2010-07-16 |
Last Update Date | 2017-01-25 |