Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003378167 |
---|---|
Provider Name | Sandy Rodriguez |
First Address | Las Vegas, NV 89103-4604 |
Second Address | Las Vegas, NV 89102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 31/07/2019 |