Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003371212 |
---|---|
Provider Name | Veronica Susbilla |
First Address | Los Angeles, CA 90010-3537 |
Second Address | Sacramento, CA 95825-6739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2019 |
Last Update Date | 01/02/2019 |