Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | CA |
NPI | 1003353319 |
---|---|
Provider Name | Jacquelyn Vargas |
First Address | Huntington Beach, CA 92649-1172 |
Second Address | Huntington Beach, CA 92649-1172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |