Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-18-68090 | CA |
NPI | 1003381906 |
---|---|
Provider Name | Sophia Rose Wuest |
First Address | Irvine, CA 92606-2417 |
Second Address | Concord, CA 94519-2623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2018 |
Last Update Date | 16/10/2018 |