Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373986 |
---|---|
Provider Name | Ms. Charmaine C Mislang |
First Address | Valley Village, CA 91607-3451 |
Second Address | Valley Village, CA 91607-3451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2019 |
Last Update Date | 20/09/2019 |