Individual
BREANNA PATINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6315 W ROOSEVELT ST, PHOENIX, AZ 85043-2418
(602) 596-9227
Mailing address
6315 W ROOSEVELT ST, PHOENIX, AZ 85043-2418
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-21-198083
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A92650491
—
AZ
Enumeration date
02/16/2022
Last updated
02/16/2022
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