Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 106S00000X | Behavior Technician |
NPI | 1003393505 |
---|---|
Provider Name | Daphney Fulgencio |
First Address | Daly City, CA 94015-3845 |
Second Address | San Bruno, CA 94066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2018 |
Last Update Date | 26/07/2019 |