Provider Demographics
NPI:1689116220
Name:ZALDUA, JACQUELINE (BCBA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ZALDUA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:ZALDUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:9466 BLACK MOUNTAIN RD
Mailing Address - Street 2:100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4550
Mailing Address - Country:US
Mailing Address - Phone:760-448-5837
Mailing Address - Fax:
Practice Address - Street 1:9466 BLACK MOUNTAIN RD
Practice Address - Street 2:100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4550
Practice Address - Country:US
Practice Address - Phone:760-448-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-16462103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst