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Individual
MRS. NIDIA DELSY PRAVONGVIENGKHAM
Active
Individual
MRS. NIDIA DELSY PRAVONGVIENGKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
IMF 54676
CA
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/20/2008
Last updated
11/14/2012
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