Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003421678 |
---|---|
Provider Name | Matthew Doan |
First Address | Huntington Beach, CA 92649-5506 |
Second Address | Huntington Beach, CA 92649-5506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |