Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-12-10099 | CA |
NPI | 1003150509 |
---|---|
Provider Name | Kristin Lundbohm |
First Address | Irvine, CA 92606-2417 |
Second Address | Chula Vista, CA 91910-2651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 17/03/2018 |