Provider Demographics
NPI:1255596235
Name:RAY, JESSI D (BCABA &CERT IN ABA)
Entity type:Individual
Prefix:MISS
First Name:JESSI
Middle Name:D
Last Name:RAY
Suffix:
Gender:F
Credentials:BCABA &CERT IN ABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 RONSON RD STE H
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1428
Mailing Address - Country:US
Mailing Address - Phone:858-278-6603
Mailing Address - Fax:858-278-6605
Practice Address - Street 1:7297 RONSON RD STE H
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1428
Practice Address - Country:US
Practice Address - Phone:858-278-6603
Practice Address - Fax:858-278-6605
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-07-2265171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0-07-2265OtherBCABA CERTIFICATION