Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0-15-6708 | CA |
NPI | 1003280967 |
---|---|
Provider Name | Aliza Klos-Young |
First Address | Escondido, CA 92025-5023 |
Second Address | San Diego, CA 92128-3425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2015 |
Last Update Date | 17/11/2015 |