Healthcare Provider Details

I. General information

NPI: 1154951689
Provider Name (Legal Business Name): JACQUELINE VERA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE ALVAREZ LOPEZ

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8591 GROVE AVE
RANCHO CUCAMONGA CA
91730-4226
US

IV. Provider business mailing address

16255 VENTURA BLVD STE 900
ENCINO CA
91436-2317
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-8923
  • Fax: 858-649-6012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: