Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | CA |
NPI | 1003404948 |
---|---|
Provider Name | Brandon Diaz |
First Address | Modesto, CA 95352-5157 |
Second Address | Dublin, CA 94568-7724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2021 |
Last Update Date | 06/01/2021 |