Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1093325680 |
---|---|
Provider Name | Caitlynn Star Cavazos |
First Address | Perris, CA 92571-3344 |
Second Address | Rancho Cucamonga, CA 91730-5938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2020 |
Last Update Date | 07/08/2020 |