Active NPI
Jensen Gorman
- Behavior Technician
- San Clemente, CA
National Provider Identifier
1104531722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1319 Calle Avanzado
San Clemente, CA 92673-6351 - Phone
- (949) 272-6146
- Fax
- (888) 847-8864
- NPI assigned
- Jan 18, 2023
- 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 Technician | 106S00000X | CA | Primary |
Addresses
Primary practice location
1319 Calle Avanzado
San Clemente, CA 92673-6351
Mailing address
602 Torrey LN Apt B
San Clemente, CA 92672-2539
Phone (636) 278-0903
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 |
|---|---|---|---|
| Evolutions ABA Inc | Behavior Technician | Current | Accepting new patients |
Locations
1319 Calle Avanzado
San Clemente, CA 92673
Phone (949) 272-6146
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681689600000",
"number": "1104531722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 TORREY LN APT B",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926722539",
"telephone_number": "636-278-0903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1319 CALLE AVANZADO",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "926736351",
"telephone_number": "949-272-6146",
"fax_number": "888-847-8864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORMAN",
"first_name": "JENSEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-18",
"last_updated": "2023-04-17",
"certification_date": "2023-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Clemente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.