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Provider Information for 1811497829

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1811497829

Calendar   Last Updated:  2018-02-16
  Certification Date: 


Name Value
NPI 1811497829
Enumeration Date 2018-02-16
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 978 HEATHER CIR APT 10
SALINAS, CA 93906-3954
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 4 ROSSI CIR STE 231
SALINAS, CA 93907-2358
United States

Phone: 831-424-5565 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 106S00000X - Behavior Technician