Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1083106082 |
---|---|
Provider Name | Krystle Rosario |
First Address | Sacramento, CA 95835-1255 |
Second Address | Sacramento, CA 95835-1255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2018 |
Last Update Date | 05/06/2018 |