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NPI Code Detail

MEDICARE: HALEY JENSEN RBT

MEDICARE: HALEY JENSEN RBT
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 TechnicianRBT-25-412652

General Provider Information

NPI Number : 1982409629
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEY JENSEN RBT
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 900
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number :
Fax Number : 720-468-4145
Provider Business Practice Location Address
First Line : 396 N MAGNOLIA AVE
Second Line :
City : EL CAJON
State : CA
Zip : 92020-3908
Country : US
Telephone Number : 801-989-9166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2025
Last Update Date : 02/17/2025

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Directions to “ HALEY JENSEN RBT” Practice Location

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