Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | CA |
NPI | 1003420654 |
---|---|
Provider Name | Jacqueline Vazquez |
First Address | Woodland Hills, CA 91367-5085 |
Second Address | Woodland Hills, CA 91367-5085 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 10/09/2020 |