Provider Demographics
NPI:1063956019
Name:ZIEMELIS, JACQUELINE CHRISTINE (BCBA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:ZIEMELIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:VANCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33568
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3568
Mailing Address - Country:US
Mailing Address - Phone:855-223-7123
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:21 RANCHO CAMINO DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7019
Practice Address - Country:US
Practice Address - Phone:855-223-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-22334103K00000X
CA11622334103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11622334OtherBACB