Jonathan Antonio Hernandez

Individual provider Active NPI Behavior Technician · Ladera Ranch, CA

NPI 1083258693 · NPPES record last updated Nov 6, 2019

Key facts

NPI
1083258693
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
License
Y3058092 (CA)
Practice address
600 Corporate Dr Ste 110
Ladera Ranch, CA 92694-2107
Phone
(949) 661-6753
NPI assigned
Nov 6, 2019
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
Y3058092CAMDBehavior Technician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Y3058092 CA Yes

Addresses

Primary practice location

600 Corporate Dr Ste 110
Ladera Ranch, CA 92694-2107

Mailing address

600 Corporate Dr Ste 110
Ladera Ranch, CA 92694-2107

Other providers in Ladera Ranch, CA

All providers in Ladera Ranch, CA · Behavior Technician in California

Sources for this page

Verify at the official NPI Registry.