Provider Demographics
NPI:1376268722
Name:ANDERSON, JANA C (BT)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 PALOMAR AIRPORT RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1451
Mailing Address - Country:US
Mailing Address - Phone:760-438-0078
Mailing Address - Fax:
Practice Address - Street 1:5573 BLUERIDGE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3404
Practice Address - Country:US
Practice Address - Phone:619-603-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician