Active NPI
Brian Wilk
- Behavior Analyst
- Fairfield, CA
National Provider Identifier
1104214923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-14-10376
- Practice address
- 2500 N Texas St
Unit a
Fairfield, CA 94533-1639 - Phone
- (707) 422-2714
- NPI assigned
- Dec 31, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | 1-14-10376 | CA | Primary |
Addresses
Primary practice location
2500 N Texas St
Unit a
Fairfield, CA 94533-1639
Mailing address
62 Dolphin Isle
Novato, CA 94949-5390
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": "1419984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419984000000",
"number": "1104214923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 DOLPHIN ISLE",
"city": "NOVATO",
"state": "CA",
"postal_code": "949495390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 N TEXAS ST",
"address_2": "UNIT A",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945331639",
"telephone_number": "707-422-2714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILK",
"first_name": "BRIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-31",
"last_updated": "2014-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-14-10376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.