Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003242835 |
---|---|
Provider Name | Keisy Diaz |
First Address | Las Vegas, NV 89118-6017 |
Second Address | Las Vegas, NV 89118-6017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2013 |
Last Update Date | 25/09/2013 |