Healthcare Provider Details

I. General information

NPI: 1568304988
Provider Name (Legal Business Name): JERADHINE ADRIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 UNIVERSITY AVE STE 207
LA MESA CA
91942-0524
US

IV. Provider business mailing address

17553 CAMINITO CANASTO
SAN DIEGO CA
92127-1107
US

V. Phone/Fax

Practice location:
  • Phone: 619-713-0737
  • Fax:
Mailing address:
  • Phone: 858-914-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-287133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: