Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003406943 |
---|---|
Provider Name | Maria D Blanco |
First Address | Oakland, CA 94601-2828 |
Second Address | Oakland, CA 94601-2828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2021 |
Last Update Date | 25/01/2021 |