Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-50539 | CA |
NPI | 1003310764 |
---|---|
Provider Name | Bethel Gebreyesus |
First Address | American Canyon, CA 94503-9654 |
Second Address | American Canyon, CA 94503-9654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 19/03/2018 |