Provider Demographics
NPI:1417628892
Name:JACOBO, ALONDRA (BACHELOR OF ARTS)
Entity type:Individual
Prefix:
First Name:ALONDRA
Middle Name:
Last Name:JACOBO
Suffix:
Gender:F
Credentials:BACHELOR OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21460 HICKS ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-6426
Mailing Address - Country:US
Mailing Address - Phone:951-322-6401
Mailing Address - Fax:
Practice Address - Street 1:21460 HICKS ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-6426
Practice Address - Country:US
Practice Address - Phone:951-322-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2948326106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician