Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003371998 |
---|---|
Provider Name | Stephanie Jimenez |
First Address | San Jose, CA 95113-2842 |
Second Address | San Jose, CA 95136-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 05/02/2019 |