Most Relevant Information
Provider Data
| NPI Number: | 1003541749 |
| Provider Name: | JORDAN JONATHAN DERAIN |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/18/2022 |
| Last Updated: | 07/18/2022 |
Provider Practice Location
36296 REDBUD LN
MURRIETA
CA
925624382
Practice Location Phone/Fax
| Phone: | 9512397078 |
| Fax: |
Provider Mailing Location
36296 REDBUD LN
MURRIETA
CA
925624382
Provider Mailing Phone/Fax
| Phone: | 9512397078 |
| Fax: |