Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-51765 | MI |
NPI | 1003306762 |
---|---|
Provider Name | Elizabeth Trujillo |
First Address | Warren, MI 48089-4757 |
Second Address | Warren, MI 48089-4757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 17/05/2018 |