Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1174080543 |
---|---|
Provider Name | Nicole Sandretto |
First Address | Glendale, CA 91206-4330 |
Second Address | Glendale, CA 91206-4330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 21/02/2019 |