Healthcare Provider Details

I. General information

NPI: 1609342344
Provider Name (Legal Business Name): JACOB DANIEL STRACENER BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 5TH AVE STE 800
SAN DIEGO CA
92101-2792
US

IV. Provider business mailing address

535 WOODLAWN AVE APT 27
CHULA VISTA CA
91910-5140
US

V. Phone/Fax

Practice location:
  • Phone: 619-730-9118
  • Fax: 323-389-2730
Mailing address:
  • Phone: 619-730-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62965
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-67467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: