Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003416553 |
---|---|
Provider Name | Daija Riley |
First Address | Anaheim, CA 92805-6807 |
Second Address | Gardena, CA 90248-4773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2020 |
Last Update Date | 26/10/2020 |