Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003414244 |
---|---|
Provider Name | Destiny Standifer |
First Address | North Highlands, CA 95660-1261 |
Second Address | Long Beach, CA 90814-1385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2020 |
Last Update Date | 10/10/2020 |