Individual
IAN JASON PETROLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5008 HOLLOW RIDGE CT, ANTIOCH, CA 94531-8074
(925) 978-4080
Mailing address
5021 WAGON WHEEL WAY, ANTIOCH, CA 94531-8428
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
0756550183
CA
Other
Enumeration date
03/04/2022
Last updated
06/30/2026
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