Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | CA | |
N | 106S00000X | Behavior Technician | 16-24985 | CA |
NPI | 1164925749 |
---|---|
Provider Name | Nicole Rivalta |
First Address | Modesto, CA 95352-5157 |
Second Address | Modesto, CA 95354-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2018 |
Last Update Date | 13/01/2020 |