Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1396157780 |
---|---|
Provider Name | Krystal Guajardo |
First Address | Sparks, NV 89431-6435 |
Second Address | Sparks, NV 89431-6435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 20/05/2014 |