Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-12-11786 | CA |
NPI | 1003359902 |
---|---|
Provider Name | Vissy Kobari Wright |
First Address | Thousand Oaks, CA 91360-7707 |
Second Address | Thousand Oaks, CA 91360-7707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2016 |
Last Update Date | 23/11/2016 |