Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373291 |
---|---|
Provider Name | Bryan Trinh |
First Address | Tustin, CA 92780-7247 |
Second Address | Tustin, CA 92780-7247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2019 |
Last Update Date | 25/02/2019 |