Provider Demographics
NPI:1942873955
Name:SANJUAMPA, AYLIN (RBT)
Entity Type:Individual
Prefix:
First Name:AYLIN
Middle Name:
Last Name:SANJUAMPA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 W 6TH ST APT 12208
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3318
Mailing Address - Country:US
Mailing Address - Phone:402-802-1924
Mailing Address - Fax:
Practice Address - Street 1:903 W 6TH ST APT 12208
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3318
Practice Address - Country:US
Practice Address - Phone:402-802-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-176593OtherBACB