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General NPI Number Information
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NPI Number | 1326525627
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Entity Type | Individual
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Provider Name | JEREMY MICHAEL HOGGATT
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Gender | Male
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 13826 HAIDER CT
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City | CORONA
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State | CA
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Zip | 92880-3213
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Country | US
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Telephone | 951-591-9211
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Fax |
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Provider Business Mailing Address
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Address Line | 674 PALM AVE SPC 9
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-1239
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Country | US
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Telephone | 619-379-5723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-61078
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License Number State | CA
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