Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003424789 |
---|---|
Provider Name | Mr. David Bravo |
First Address | Van Nuys, CA 91405-2003 |
Second Address | Van Nuys, CA 91405-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2020 |
Last Update Date | 17/07/2020 |