MEDICARE: JACOB ALLEN ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1104768266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ALLEN ANDERSON

Provider Business Mailing Address
First Line	:	421 N BROOKHURST ST STE 130
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5618
Country	:	US
Telephone Number	:	714-831-1295
Fax Number	:	714-984-0281

Provider Business Practice Location Address
First Line	:	421 N BROOKHURST ST STE 130
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-5618
Country	:	US
Telephone Number	:	714-831-1295
Fax Number	:	714-984-0281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ JACOB ALLEN ANDERSON ” Practice Location

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