Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003375403 |
---|---|
Provider Name | Cynthia Crystal Perez Urbano |
First Address | Fullerton, CA 92833-3464 |
Second Address | Brea, CA 92821-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2019 |
Last Update Date | 15/03/2019 |