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General NPI Number Information
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NPI Number | 1942572045
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Entity Type | Individual
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Provider Name | JEFFERSON ADRIAN BCBA
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Gender | Male
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 601 UNIVERSITY AVE SUITE 175
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City | SACRAMENTO
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State | CA
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Zip | 95825-6775
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Country | US
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Telephone | 323-866-1880
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Fax | 323-866-1881
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Provider Business Mailing Address
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Address Line | 4221 WILSHIRE BLVD SUITE 300A
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City | LOS ANGELES
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State | CA
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Zip | 90010-3512
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Country | US
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Telephone | 323-866-1880
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Fax | 323-866-1881
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-11-8413
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License Number State |
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