Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | CA |
NPI | 1003317306 |
---|---|
Provider Name | Rafael Olivares Chayeb |
First Address | Irvine, CA 92606-2417 |
Second Address | Chula Vista, CA 91910-2651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 25/06/2019 |