Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003406224 |
---|---|
Provider Name | Brooklyn Gonzalez |
First Address | San Diego, CA 92108-1669 |
Second Address | San Diego, CA 92123-1842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2021 |
Last Update Date | 21/01/2021 |