Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-12-10277 | FL |
NPI | 1003151465 |
---|---|
Provider Name | Mrs. Amber Rae Pool |
First Address | South Pasadena, CA 91030-2694 |
Second Address | Los Angeles, CA 90017-1823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2012 |
Last Update Date | 11/12/2012 |