Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003371055 |
---|---|
Provider Name | Brian Gonsalez |
First Address | Walnut Creek, CA 94598-2538 |
Second Address | Oakland, CA 94612-3769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2019 |
Last Update Date | 04/02/2019 |