Healthcare Provider Details

I. General information

NPI: 1396534897
Provider Name (Legal Business Name): JESSE PARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 OCEANSIDE BLVD STE T
OCEANSIDE CA
92056-5821
US

IV. Provider business mailing address

3652 MICHELSON DR
IRVINE CA
92612-1727
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-1493
  • Fax:
Mailing address:
  • Phone: 949-474-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-429875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: