Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 17-42909 | CA |
NPI | 1003323627 |
---|---|
Provider Name | Karla Jamileth Moran |
First Address | Stockton, CA 95210-5320 |
Second Address | Stockton, CA 95210-5320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2018 |
Last Update Date | 04/01/2018 |