Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | NM |
NPI | 1003372798 |
---|---|
Provider Name | Angela Martinez |
First Address | Farmington Hills, MI 48334-5326 |
Second Address | Peralta, NM 87042-8817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2019 |
Last Update Date | 01/07/2019 |