Provider Demographics
NPI:1245670272
Name:DESTANOVIC, JASMINA (BCBA)
Entity type:Individual
Prefix:
First Name:JASMINA
Middle Name:
Last Name:DESTANOVIC
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25362 PACIFICA AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3854
Mailing Address - Country:US
Mailing Address - Phone:949-241-0142
Mailing Address - Fax:
Practice Address - Street 1:25362 PACIFICA AVE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3854
Practice Address - Country:US
Practice Address - Phone:949-241-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13713103K00000X
1-13-13713103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst