Provider Demographics
NPI:1114437977
Name:ARVIZU, JILLIAN ROBINSON (BCBA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ROBINSON
Last Name:ARVIZU
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 REBECCA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3548
Mailing Address - Country:US
Mailing Address - Phone:831-214-4894
Mailing Address - Fax:
Practice Address - Street 1:8910 UNIVERSITY CENTER LN STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1025
Practice Address - Country:US
Practice Address - Phone:036-692-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-26208103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst