Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA |
NPI | 1003574187 |
---|---|
Provider Name | Malaya Faith Dodson |
First Address | Costa Mesa, CA 92626-4650 |
Second Address | Costa Mesa, CA 92626-4650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2021 |
Last Update Date | 06/12/2021 |