Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | FL |
NPI | 1134637184 |
---|---|
Provider Name | Jaclyn Emanuelle Trujillo |
First Address | West Miami, FL 33144-4940 |
Second Address | Miami, FL 33173-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 22/06/2019 |