Individual
ANGELINA KOESNODIHARDJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
957 INDUSTRIAL RD, SUITE B, SAN CARLOS, CA 94070-4151
(415) 941-1751
(650) 620-9549
Mailing address
PO BOX 70, REDWOOD CITY, CA 94064-0070
(650) 260-5041
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/07/2011
Last updated
07/29/2015
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