Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003375593 |
---|---|
Provider Name | Raul Omar Roman Rodriguez |
First Address | Fullerton, CA 92832-1612 |
Second Address | Fullerton, CA 92832-1612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 14/03/2019 |