Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373879 |
---|---|
Provider Name | Crystal Monique Loza |
First Address | Clovis, CA 93612-0311 |
Second Address | Clovis, CA 93612-0311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2019 |
Last Update Date | 27/02/2019 |