Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003379553 |
---|---|
Provider Name | Jacqueline Jasmin Jacobo |
First Address | Irvine, CA 92606-2417 |
Second Address | Cerritos, CA 90703-2144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2019 |
Last Update Date | 11/04/2019 |