Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-44621 | CA |
N | 106S00000X | Behavior Technician |
NPI | 1003424557 |
---|---|
Provider Name | Ryan Jacob Barroso |
First Address | Goleta, CA 93117-2859 |
Second Address | Goleta, CA 93117-2859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 15/07/2021 |