Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA |
NPI | 1003189523 |
---|---|
Provider Name | Michael Tagle |
First Address | Thousand Oaks, CA 91360-7824 |
Second Address | Thousand Oaks, CA 91360-7824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |