Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003400268 |
---|---|
Provider Name | Marvin Colon |
First Address | Napa, CA 94558-2414 |
Second Address | Napa, CA 94558-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2021 |
Last Update Date | 26/02/2021 |