Individual provider Active NPI

Alexander Ayala, RBT-18-52915

  • Behavior Technician
  • Itasca, IL
National Provider Identifier
1023508140
Registry record updated May 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
18-52915 Issued in IL
Practice address
528 Hickory Dr
Itasca, IL 60143-1653
Phone
(630) 414-9504
NPI assigned
May 14, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X 18-52915 IL Primary

Addresses

Primary practice location

528 Hickory Dr
Itasca, IL 60143-1653

Mailing address

528 Hickory Dr
Itasca, IL 60143-1653

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

State licenses

LicenseStateTypeSpecialty
18-52915ILMDBehavior Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526256000000",
    "number": "1023508140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 HICKORY DR",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601431653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 HICKORY DR",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "601431653",
            "telephone_number": "630-414-9504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYALA",
        "first_name": "ALEXANDER",
        "credential": "RBT-18-52915",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-14",
        "last_updated": "2018-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IL",
            "license": "18-52915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Itasca, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.