Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373937 |
---|---|
Provider Name | Mindy Redondo |
First Address | Glendale, CA 91206-4330 |
Second Address | San Jose, CA 95129-4934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2019 |
Last Update Date | 27/02/2019 |