Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373408 |
---|---|
Provider Name | Llareli Palestino |
First Address | Costa Mesa, CA 92626-1517 |
Second Address | Costa Mesa, CA 92626-1517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2019 |
Last Update Date | 22/02/2019 |