Individual
JORGE ISMAEL RIVERA CARRASQUILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
737 FAWCETT AVE, TACOMA, WA 98402-5503
(253) 396-5097
Mailing address
737 FAWCETT AVE, TACOMA, WA 98402-5503
(253) 396-5097
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/30/2024
Last updated
08/30/2024
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