Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst |
NPI | 1003195421 |
---|---|
Provider Name | Mrs. Marisela Gonzales I |
First Address | North Las Vegas, NV 89031-9009 |
Second Address | North Las Vegas, NV 89032-8929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 26/10/2015 |