Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003422379 |
---|---|
Provider Name | Bianca Grant |
First Address | Pasadena, CA 91105-1901 |
Second Address | San Jose, CA 95129-4965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2020 |
Last Update Date | 21/09/2020 |