Healthcare Provider Details

I. General information

NPI: 1942603246
Provider Name (Legal Business Name): JESUS RODELA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 W SHAW AVE SUITE 102
FRESNO CA
93711-3516
US

IV. Provider business mailing address

19019 VENTURA BLVD
TARZANA CA
91356-3253
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-5900
  • Fax: 559-255-3900
Mailing address:
  • Phone: 818-345-2345
  • Fax: 818-758-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-10246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: