Most Relevant Information
Provider Data
| NPI Number: | 1003322819 |
| Provider Name: | JERRY LUONG |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/17/2017 |
| Last Updated: | 12/17/2017 |
Provider Practice Location
29122 RANCHO VIEJO RD STE 206
SAN JUAN CAPISTRANO
CA
926751039
Practice Location Phone/Fax
| Phone: | 9493350254 |
| Fax: |
Provider Mailing Location
29122 RANCHO VIEJO RD STE 206
SAN JUAN CAPISTRANO
CA
926751039
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |