MEDICARE: JACQUELINE VERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1976830	OTHER	CA	RBT

General Provider Information

NPI Number	:	1154951689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE VERA

Provider Business Mailing Address
First Line	:	7141 WOODLEY AVE
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-3932
Country	:	US
Telephone Number	:	818-285-8252
Fax Number	:	818-273-1831

Provider Business Practice Location Address
First Line	:	1737 ATLANTA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2442
Country	:	US
Telephone Number	:	818-285-8252
Fax Number	:	818-273-1831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	10/22/2025

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Directions to “ JACQUELINE VERA ” Practice Location

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