Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-15-03547 | CA |
NPI | 1003324062 |
---|---|
Provider Name | Adam Hart |
First Address | Oceanside, CA 92058-1201 |
Second Address | Oceanside, CA 92058-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 11/01/2018 |