Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-145478 | CA |
NPI | 1003411422 |
---|---|
Provider Name | Amy Balfanz-Gutierrez |
First Address | Northbrook, IL 60062-8005 |
Second Address | San Diego, CA 92126-4442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 02/12/2020 |