Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-17886 |
NPI | 1003303785 |
---|---|
Provider Name | Jill M Craven |
First Address | Rancho Cucamonga, CA 91730-5938 |
Second Address | Rancho Cucamonga, CA 91730-5938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 18/04/2018 |