Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003374240 |
---|---|
Provider Name | Maggie Baboomian |
First Address | Irvine, CA 92612-4639 |
Second Address | Garden Grove, CA 92840-4694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 07/03/2019 |