Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | ||
Y | 106S00000X | Behavior Technician |
NPI | 1114496932 |
---|---|
Provider Name | Roberto Ivan Garcia Sandoval |
First Address | Lakewood, CO 80228-6514 |
Second Address | San Jose, CA 95126-3407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2018 |
Last Update Date | 21/11/2018 |