Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003409178 |
---|---|
Provider Name | Johanna Marquez |
First Address | Santa Ana, CA 92705-7875 |
Second Address | Riverside, CA 92518-3014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2021 |
Last Update Date | 18/02/2021 |