Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | Y3924378 | CA |
NPI | 1003304163 |
---|---|
Provider Name | Skyler Kimberly Gruener |
First Address | Woodland Hills, CA 91367-4976 |
Second Address | Santa Fe Springs, CA 90670-3344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 24/04/2018 |