Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | M630-4019-9767 | IL |
NPI | 1003383712 |
---|---|
Provider Name | Isabella Angelina Moretti |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Naperville, IL 60563-4908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2018 |
Last Update Date | 31/10/2018 |