MEDICARE: MANEESHA S JAYAKUMAR

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	106S00000X	Behavior Technician	19-93377	CA

General Provider Information

NPI Number	:	1770139297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANEESHA S JAYAKUMAR

Provider Business Mailing Address
First Line	:	280 CASTELLANA S
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-2159
Country	:	US
Telephone Number	:	917-618-3851
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 CASTELLANA S
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-2159
Country	:	US
Telephone Number	:	917-618-3851
Fax Number	:

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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