Marcus Broussard
Behavior Technician in Rowland Heights, CA. Individual provider (NPI-1).
NPI number1124771027
StatusActive
Last updated in NPPESJan 31, 2022
Details
- NPI
- 1124771027
- Entity type
- Individual (NPI-1)
- Name
- Marcus Broussard
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 31, 2022
- Certification date
- Jan 31, 2022
- Last updated
- Jan 31, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
17462 Colima RdRowland Heights, CA 91748-1633
Phone 855-223-7123 · Fax 619-550-6368
Mailing address
16782 Von Karman Ave Ste 11Irvine, CA 92606-2417
Phone 855-223-7123 · Fax 619-550-6368
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