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1003530122
MATTHEW PROVENCIO
SACRAMENTO, CA
NPI
1003530122
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2022-10-03
Last Update Date
2022-10-03
Business Address
MATTHEW PROVENCIO
800 HOWE AVE STE 140
SACRAMENTO, CA 95825-3965
Phone number: 855-223-7123
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Mailing Address
MATTHEW PROVENCIO
16782 VON KARMAN AVE STE 11
IRVINE, CA 92606-2417
Phone number: 855-223-7123
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