Individual provider Active NPI

Mateo Ezequiel Ortiz Cuesta

  • Day Training/Habilitation Specialist
  • Fort Bragg, CA
National Provider Identifier
1104639178
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Day Training/Habilitation SpecialistTaxonomy code 373H00000X
Practice address
101 N Franklin St
Fort Bragg, CA 95437-3602
Phone
(707) 941-0859
NPI assigned
Jan 31, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Day Training/Habilitation Specialist 373H00000X Primary

Addresses

Primary practice location

101 N Franklin St
Fort Bragg, CA 95437-3602

Mailing address

101 N Franklin St
Fort Bragg, CA 95437-3602
Phone (707) 941-0859

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mateo@mendocinochc.org 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": "1738281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1104639178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N FRANKLIN ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954373602",
            "telephone_number": "707-941-0859",
            "fax_number": "844-388-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N FRANKLIN ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954373602",
            "telephone_number": "707-941-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ CUESTA",
        "first_name": "MATEO",
        "middle_name": "EZEQUIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-31",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mateo@mendocinochc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "101 N Franklin St",
            "city": "Fort Bragg",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954373602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Bragg, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.