Individual
VERA LUCIA MAYORGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
816 BONITA ST APT B, MONROVIA, CA 91016
(323) 979-9381
Mailing address
816 BONITA ST APT B, MONROVIA, CA 91016-7629
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
40783
CA
Other
Enumeration date
05/29/2018
Last updated
06/18/2018
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