Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-19-101954 | NV |
NPI | 1003379546 |
---|---|
Provider Name | Sandra Daniela Valenzuela |
First Address | Las Vegas, NV 89102-1933 |
Second Address | Las Vegas, NV 89102-1933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2019 |
Last Update Date | 14/10/2019 |