Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | F2065408 | CA |
NPI | 1104471374 |
---|---|
Provider Name | Gabrielle Marie Phillips |
First Address | San Jose, CA 95136-1305 |
Second Address | San Jose, CA 95136-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 05/08/2019 |