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NPI Code Detail

MEDICARE: JACK JAVIER BRICENO

MEDICARE: JACK JAVIER BRICENO
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1326991019
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK JAVIER BRICENO
Provider Business Mailing Address
First Line : 713 W COMMONWEALTH AVE
Second Line :
City : FULLERTON
State : CA
Zip : 92832-1612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 713 W COMMONWEALTH AVE
Second Line :
City : FULLERTON
State : CA
Zip : 92832-1612
Country : US
Telephone Number : 714-879-4274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2026
Last Update Date : 02/20/2026

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Directions to “ JACK JAVIER BRICENO ” Practice Location

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