Healthcare Provider Details

I. General information

NPI: 1316101603
Provider Name (Legal Business Name): JENNIFER YAKOS B.A., M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7297 RONSON RD STE H
SAN DIEGO CA
92111-1428
US

IV. Provider business mailing address

4733 49TH ST
SAN DIEGO CA
92115-1902
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-6603
  • Fax: 858-278-6605
Mailing address:
  • Phone: 619-248-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1-04-1938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: