Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-15-01840 |
NPI | 1003383100 |
---|---|
Provider Name | Lysandra Garcia |
First Address | Round Rock, TX 78664-7072 |
Second Address | San Antonio, TX 78258-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2018 |
Last Update Date | 26/10/2018 |