Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-15-18108 | CA |
NPI | 1003203175 |
---|---|
Provider Name | Ms. Jana Rachel Goldberg |
First Address | San Diego, CA 92123-4632 |
Second Address | San Diego, CA 92101-3546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 18/10/2019 |