Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1083163166 |
---|---|
Provider Name | Stormy Tovar |
First Address | Martinez, CA 94553-6563 |
Second Address | San Leandro, CA 94577-4611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2016 |
Last Update Date | 29/09/2016 |