Provider Demographics
NPI:1942572045
Name:ADRIAN, JEFFERSON (BCBA)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:
Last Name:ADRIAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3512
Mailing Address - Country:US
Mailing Address - Phone:323-866-1880
Mailing Address - Fax:323-866-1881
Practice Address - Street 1:601 UNIVERSITY AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6775
Practice Address - Country:US
Practice Address - Phone:323-866-1880
Practice Address - Fax:323-866-1881
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8413103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst