Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1033712641 |
---|---|
Provider Name | Jose Gonzalez |
First Address | Visalia, CA 93278-5091 |
Second Address | Visalia, CA 93292-9297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2020 |
Last Update Date | 17/11/2020 |