Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003312133 |
---|---|
Provider Name | Jacqueline Guadalupe Anguiano |
First Address | Cotati, CA 94931-4362 |
Second Address | Petaluma, CA 94952-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2018 |
Last Update Date | 05/04/2018 |