Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-55098 | CA |
NPI | 1003323718 |
---|---|
Provider Name | Lyzandra Nieves |
First Address | San Leandro, CA 94577-5933 |
Second Address | Walnut Creek, CA 94598-2667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2018 |
Last Update Date | 20/11/2021 |