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NPI Code Detail

MEDICARE: WAYNE JARVIS

MEDICARE: WAYNE JARVIS
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 Technician

General Provider Information

NPI Number : 1588513154
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE JARVIS
Provider Business Mailing Address
First Line : 100 N PACIFIC COAST HWY STE 1400
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 626 W LANCASTER BLVD # 52
Second Line :
City : LANCASTER
State : CA
Zip : 93534-3108
Country : US
Telephone Number : 661-258-3211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2026
Last Update Date : 01/26/2026

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Directions to “ WAYNE JARVIS ” Practice Location

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