Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
N | 106S00000X | Behavior Technician |
NPI | 1013524719 |
---|---|
Provider Name | Richard David Noel |
First Address | Tucson, AZ 85752-1493 |
Second Address | Tucson, AZ 85741-4042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2020 |
Last Update Date | 26/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
601637737 | (05) | AZ |