Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA |
NPI | 1003491457 |
---|---|
Provider Name | Jessica Nicole King |
First Address | Los Angeles, CA 90008-4315 |
Second Address | Los Angeles, CA 90008-4315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2021 |
Last Update Date | 16/03/2021 |