Active NPI
Carolina A Cordova, BCBA
- Behavior Analyst
- Sacramento, CA
National Provider Identifier
1013689496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-21-53332
- Practice address
- 1300 Ethan Way Ste 175
Sacramento, CA 95825-2277 - Phone
- (866) 523-4268
- NPI assigned
- Oct 4, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Behavior Analyst | 103K00000X | 1-21-53332 | CA | Primary |
Addresses
Primary practice location
1300 Ethan Way Ste 175
Sacramento, CA 95825-2277
Mailing address
Dept la 22763
Pasadena, CA 91185-2763
Phone (866) 523-4268
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497292965 | Other | CA | BAY ABA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ccordova@bayaba.com |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Junior Boom ABA LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Brooklyn, NY
- NPI 1861194490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1013689496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT LA 22763",
"city": "PASADENA",
"state": "CA",
"postal_code": "911852763",
"telephone_number": "866-523-4268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 ETHAN WAY STE 175",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958252277",
"telephone_number": "866-523-4268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDOVA",
"first_name": "CAROLINA",
"middle_name": "A",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-04",
"last_updated": "2023-05-15",
"certification_date": "2023-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-21-53332",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BAY ABA",
"identifier": "1497292965",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ccordova@bayaba.com",
"affiliation": "N",
"address_1": "1625 The Alameda Ste 615",
"city": "San Jose",
"state": "CA",
"country_code": "US",
"postal_code": "951262224",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.