Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1003472531 |
---|---|
Provider Name | Jessica Spinks |
First Address | Camarillo, CA 93010-5919 |
Second Address | Camarillo, CA 93010-5919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2019 |
Last Update Date | 09/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F1436400 | DRIVER LICENSE (01) | CA |