Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003397092 |
---|---|
Provider Name | Amanda Romine |
First Address | Sacramento, CA 95834-2637 |
Second Address | Sacramento, CA 95825-4299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |