Individual
ANIKA SAMORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4710 EAGLERIDGE CIR, PUEBLO, CO 81008-2176
(719) 582-8736
Mailing address
4710 EAGLERIDGE CIR, PUEBLO, CO 81008-2176
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
BACB704555
CO
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/01/2022
Last updated
09/20/2022
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