Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | ||
Y | 106S00000X | Behavior Technician |
NPI | 1104385509 |
---|---|
Provider Name | Braulio Longoria |
First Address | Lakewood, CO 80228-6514 |
Second Address | Dallas, TX 75254-7899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2019 |
Last Update Date | 18/03/2019 |