Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003386210 |
---|---|
Provider Name | Kaija Roze Bales |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Albuquerque, NM 87111-2060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2018 |
Last Update Date | 25/05/2021 |