Healthcare Provider Details

I. General information

NPI: 1992625040
Provider Name (Legal Business Name): JOCELYN TAVARES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RANCHO CAMINO DR
POMONA CA
91766-7030
US

IV. Provider business mailing address

1024 DRIFTWOOD CIR
BANNING CA
92220-6303
US

V. Phone/Fax

Practice location:
  • Phone: 909-634-3974
  • Fax:
Mailing address:
  • Phone: 951-809-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: