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NPI Code Detail

MEDICARE: JACQUELINE JACOBO

MEDICARE: JACQUELINE JACOBO
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 : 1760313076
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE JACOBO
Provider Business Mailing Address
First Line : 612 S MYRTLE AVE STE 10
Second Line :
City : MONROVIA
State : CA
Zip : 91016-3406
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4508 N SIERRA WAY
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92407-3854
Country : US
Telephone Number : 909-683-6022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ JACQUELINE JACOBO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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