Dereka Isyiss Mayome Mathis
Behavior Technician in Sacramento, CA. Individual provider (NPI-1).
NPI number1194415323
StatusActive
Last updated in NPPESMay 10, 2023
Details
- NPI
- 1194415323
- Entity type
- Individual (NPI-1)
- Name
- Miss Dereka Isyiss Mayome Mathis
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 10, 2023
- Certification date
- May 4, 2023
- Last updated
- May 10, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
3840 Rosin Ct Ste 130Sacramento, CA 95834-1699
Phone 916-374-0800
Mailing address
3840 Rosin Ct Ste 130Sacramento, CA 95834-1699
Phone 916-374-0800
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