Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003371535 |
---|---|
Provider Name | Wesley Mapua Rodriguez |
First Address | Citrus Heights, CA 95621-1741 |
Second Address | Fair Oaks, CA 95628-5332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2019 |
Last Update Date | 08/02/2019 |