Individual
AVERY GRACE PROSPERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 S MAIN ST, ORANGE, CA 92868-4507
(657) 565-3259
Mailing address
500 S MAIN ST, ORANGE, CA 92868-4507
(675) 565-3259
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
02/21/2025
Last updated
02/21/2025
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