Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003301615 |
---|---|
Provider Name | Marisol Rodriguez |
First Address | Monrovia, CA 91016-8013 |
Second Address | Monrovia, CA 91016-8013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 11/12/2018 |