Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 247200000X | CA |
NPI | 1063905651 |
---|---|
Provider Name | Sandra Patricia Moncada |
First Address | Santa Maria, CA 93454-6608 |
Second Address | Santa Maria, CA 93454-6608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2018 |
Last Update Date | 08/06/2018 |