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General NPI Number Information
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NPI Number | 1689338733
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Entity Type | Individual
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Provider Name | DESTINY DY
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 1915 HOWARD RD STE B&C
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City | MADERA
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State | CA
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Zip | 93637-5163
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Country | US
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Telephone | 559-330-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 840 ROYAL DR
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City | MADERA
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State | CA
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Zip | 93637-2998
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Country | US
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Telephone | 510-329-0736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | Y6519256
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License Number State | CA
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