Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003388836 |
---|---|
Provider Name | Mariah Selena Rivera |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Santa Fe, NM 87507-4958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2018 |
Last Update Date | 18/12/2018 |