Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003392663 |
---|---|
Provider Name | Ricardo Urrea |
First Address | Van Nuys, CA 91406-3613 |
Second Address | San Diego, CA 92123-4399 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 17/07/2018 |