Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA |
NPI | 1003397803 |
---|---|
Provider Name | Julia Marie Jaciuk |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Valencia, CA 91355-3484 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2018 |
Last Update Date | 28/08/2018 |