| NPI | 1902016348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA PETRUS Secretary 805-496-6180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY17390) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY19903) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-09-18 |