Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003418336 |
---|---|
Provider Name | Malia Bert |
First Address | Modesto, CA 95350-0155 |
Second Address | Modesto, CA 95350-0155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2020 |
Last Update Date | 11/11/2020 |