Individual
JUSTIN DE ANGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
51 NE LAURA LN, BELFAIR, WA 98528-9441
(206) 679-0914
Mailing address
51 NE LAURA LN, BELFAIR, WA 98528-9441
(206) 679-0914
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
02/01/2017
Last updated
03/09/2017
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