Individual
JENICCA BASTIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9620 CHESAPEAKE DR STE 105, SAN DIEGO, CA 92123-1324
(858) 505-9083
Mailing address
9450 GILMAN DR # 65599, LA JOLLA, CA 92092-0102
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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