Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1134667660 |
---|---|
Provider Name | Brittany Tyler |
First Address | San Diego, CA 92172-0072 |
Second Address | San Diego, CA 92103-4321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2017 |
Last Update Date | 03/02/2017 |