Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003409681 |
---|---|
Provider Name | Marlene Macias |
First Address | Pasadena, CA 91106-2380 |
Second Address | Ontario, CA 91761-8554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2021 |
Last Update Date | 15/02/2021 |