Facts
- Status
- A
- Credential
- MA BCBA
- Type
- Individual
- Enumeration date
- 2023-03-02
- Last updated
- 2023-03-02
Specialties
Licenses
- License CA
- 1-21-55624
Location
- Practice location
- 10453 NATIONS CIR
- City
- STOCKTON CA
- Postal code
- 952094550
- Phone
- 209-607-3481
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.