Provider Demographics
NPI:1518779693
Name:OLIVA, JAYLEN AURION RAMON
Entity type:Individual
Prefix:MR
First Name:JAYLEN
Middle Name:AURION RAMON
Last Name:OLIVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12755 AMARANTH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3633
Mailing Address - Country:US
Mailing Address - Phone:619-871-3541
Mailing Address - Fax:
Practice Address - Street 1:2141 PALOMAR AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1423
Practice Address - Country:US
Practice Address - Phone:760-710-2460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician