Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 11314180 | CA |
N | 103TS0200X | School Psychologist | 101091874 | CA |
NPI | 1013332097 |
---|---|
Provider Name | Joan Shin |
First Address | San Diego, CA 92129-1218 |
Second Address | San Diego, CA 92123-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2014 |
Last Update Date | 27/02/2014 |