Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1033609201 |
---|---|
Provider Name | Stephanie Lugo |
First Address | San Diego, CA 92128-3415 |
Second Address | San Diego, CA 92121-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 02/07/2021 |