MEDICARE: JACIEL BERNAL SANTOS

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		CA
2	2355S0801X	Speech-Language Assistant		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629854641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACIEL BERNAL SANTOS

Provider Business Mailing Address
First Line	:	5710 DODD ST
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	91752-2307
Country	:	US
Telephone Number	:	951-347-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	5710 DODD ST
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	91752-2307
Country	:	US
Telephone Number	:	951-347-7311
Fax Number	:

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

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	06/07/2026

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Directions to “ JACIEL BERNAL SANTOS ” Practice Location

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