Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT1618639 | CA |
NPI | 1003342577 |
---|---|
Provider Name | Caitlyn Verdugo |
First Address | Honolulu, HI 96813-4902 |
Second Address | Honolulu, HI 96813-4902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2017 |
Last Update Date | 03/05/2017 |