Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003420159 |
---|---|
Provider Name | Adrian Gutierrez |
First Address | Stockton, CA 95206-6376 |
Second Address | Stockton, CA 95219-5435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2020 |
Last Update Date | 05/09/2020 |