Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-9831 | |
N | 106S00000X | Behavior Technician | RBT-18-56671 |
NPI | 1043710379 |
---|---|
Provider Name | Miss Cynthia Gomez |
First Address | Las Vegas, NV 89119-5190 |
Second Address | Las Vegas, NV 89119-5190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 25/06/2019 |