Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | VA |
NPI | 1003388182 |
---|---|
Provider Name | Jessica Guevara |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Manassas, VA 20109-2338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2018 |
Last Update Date | 29/12/2018 |