Healthcare Provider Details

I. General information

NPI: 1376166090
Provider Name (Legal Business Name): JESSE MICHAEL BELC BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 CAMINO DEL RIO S STE 100
SAN DIEGO CA
92108-3822
US

IV. Provider business mailing address

151 W GLAUCUS ST UNIT D
ENCINITAS CA
92024-1415
US

V. Phone/Fax

Practice location:
  • Phone: 850-405-7675
  • Fax: 801-658-2798
Mailing address:
  • Phone: 850-405-7675
  • Fax: 801-658-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: