Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1174000731 |
---|---|
Provider Name | Raquel Cline |
First Address | Stockton, CA 95219-4555 |
Second Address | Turlock, CA 95382-2713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2018 |
Last Update Date | 25/07/2018 |