Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003369604 |
---|---|
Provider Name | Erica Candelaria |
First Address | Albuquerque, NM 87120-5397 |
Second Address | Albuquerque, NM 87120-5397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2016 |
Last Update Date | 31/07/2016 |