Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003375932 |
---|---|
Provider Name | Julio Gutierrez |
First Address | Santa Ana, CA 92705-3731 |
Second Address | Santa Ana, CA 92705-3731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2019 |
Last Update Date | 19/03/2019 |