Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1164182309 |
---|---|
Provider Name | Alexis Kiana Anderson |
First Address | San Diego, CA 92123-1324 |
Second Address | San Diego, CA 92123-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2021 |
Last Update Date | 29/12/2021 |