Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-51628 | CA |
N | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician | RBT-17-31640 | CA |
NPI | 1104329531 |
---|---|
Provider Name | Adam William De Los Santos |
First Address | Modesto, CA 95352-5157 |
Second Address | Tracy, CA 95377-8119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 19/07/2021 |