Individual
KOMANECHE T MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SCHOOL PSYCHOLOGIST
Contact information
Practice address
665 W WINCHESTER DR, RIALTO, CA 92376-3237
(951) 809-3592
Mailing address
665 W WINCHESTER DR, RIALTO, CA 92376-3237
(951) 809-3592
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
343535
NM
Other
Enumeration date
01/24/2011
Last updated
10/21/2013
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