Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-20-141278 | CA |
NPI | 1003415761 |
---|---|
Provider Name | Elissa Rae Apodaca |
First Address | Winchester, CA 92596-9138 |
Second Address | Temecula, CA 92591-4659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2020 |
Last Update Date | 22/10/2020 |