Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-19-83272 | CA |
NPI | 1003378472 |
---|---|
Provider Name | Jillian Crosby |
First Address | Temecula, CA 92590-5626 |
Second Address | Temecula, CA 92590-5626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |