Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA |
NPI | 1003412321 |
---|---|
Provider Name | Larisa Pamujac |
First Address | Los Angeles, CA 90010-3537 |
Second Address | Sacramento, CA 95826-2345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2020 |
Last Update Date | 10/12/2020 |