Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | BCABA: 0-11-4018 | CA |
NPI | 1003104217 |
---|---|
Provider Name | Shelby Marie Miner |
First Address | San Diego, CA 92103-4383 |
Second Address | El Paso, TX 79912-5568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 03/04/2013 |