Most Relevant Information
Provider Data
| NPI Number: | 1003560160 |
| Provider Name: | PERLA MONDRAGON |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/08/2022 |
| Last Updated: | 02/08/2022 |
Provider Practice Location
4232 N WATERFORD PL
BOISE
ID
837033490
Practice Location Phone/Fax
| Phone: | 2088712102 |
| Fax: |
Provider Mailing Location
4232 N WATERFORD PL
BOISE
ID
837033490
Provider Mailing Phone/Fax
| Phone: | 2088712102 |
| Fax: |