Healthcare Provider Details

I. General information

NPI: 1205771565
Provider Name (Legal Business Name): JOCELYN PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7422 GARVEY AVE UNIT 204
ROSEMEAD CA
91770-2974
US

IV. Provider business mailing address

233 CALIFORNIA ST APT B
SANTA PAULA CA
93060-5608
US

V. Phone/Fax

Practice location:
  • Phone: 626-531-6999
  • Fax:
Mailing address:
  • Phone: 805-200-0337
  • 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: