Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003372699 |
---|---|
Provider Name | Emily Vizcarra |
First Address | Lake Elsinore, CA 92530-1816 |
Second Address | Temecula, CA 92592-9672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 19/02/2019 |