Active NPI
Ica Datinguinoo Cabral, BCBA
- Behavior Analyst
- San Mateo, CA
National Provider Identifier
1013599307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 3130 La Selva St Ste 104
San Mateo, CA 94403-2190 - Phone
- (650) 232-4105
- Fax
- (650) 332-2333
- NPI assigned
- Apr 26, 2021
- Last updated
- Apr 26, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | CA | Primary |
Addresses
Primary practice location
3130 La Selva St Ste 104
San Mateo, CA 94403-2190
Mailing address
1625 The Alameda Ste 615
San Jose, CA 95126-2224
Phone (650) 232-4105
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 814394030 | Other | CA | N/A |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | CentralReach | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619395200000",
"number": "1013599307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 THE ALAMEDA STE 615",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951262224",
"telephone_number": "650-232-4105",
"fax_number": "650-250-5326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3130 LA SELVA ST STE 104",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944032190",
"telephone_number": "650-232-4105",
"fax_number": "650-332-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CABRAL",
"first_name": "ICA",
"middle_name": "DATINGUINOO",
"name_prefix": "Miss",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-26",
"last_updated": "2021-04-26",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "N/A",
"identifier": "814394030",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "CentralReach",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "PDF",
"address_1": "3130 La Selva St Ste 104",
"city": "San Mateo",
"state": "CA",
"country_code": "US",
"postal_code": "944032190",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.