Doctor Name: | MARTIN CONSUEGRA |
NPI Number: | 1003934332 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | IMF49635 |
Business Practice Address: | 850 E Wardlow Rd Long Beach, CA - 908074628 |
Business Phone Number: | 5629819392 |
Business Fax Number: | |
Mailing Address: | 850 E Wardlow Rd, LONG BEACH |
State: | CA |
Postal Code: | 908074628 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/26/2007 |
NPI Last Update Date: | 01/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMF49635 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |