Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | D7695255 | CA |
NPI | 1003305822 |
---|---|
Provider Name | Susana Esquivel |
First Address | Reseda, CA 91335-4609 |
Second Address | Newhall, CA 91321-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2018 |
Last Update Date | 07/05/2018 |