Maryellie Jacquez

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

D5897194 Issued in CA

Practice address

301 S la Cadena Dr
Colton, CA 92324-3419

Phone

(909) 219-5260

Fax

(909) 264-3728

NPI assigned

May 23, 2018

Last updated

Dec 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764892800000",
    "number": "1124519335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S LA CADENA DR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243419",
            "telephone_number": "909-219-5260",
            "fax_number": "909-264-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S LA CADENA DR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923243419",
            "telephone_number": "909-219-5260",
            "fax_number": "909-264-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUEZ",
        "first_name": "MARYELLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-23",
        "last_updated": "2025-12-05",
        "certification_date": "2025-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "D5897194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carey Lucile Jackson, MA
• Jennifer Jackson, MD
• Geonna Jacobs
• Marilyn Frances Jacobs
• Jesse J. Jacquez, P.A.-C.
• Erin Jaeger, PA-C
• Ned-Louise Jaggers, OTA/L
• Anika Jallorina
• Ali Jamehdor, D.O
• James T Jesse DDS Inc

• Behavior Analyst in Colton, CA
• Providers in Colton, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.