Active NPI
Camilo Isaza
- Behavior Technician
- Brooklyn, NY
National Provider Identifier
1114495025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 147 Prince St
Brooklyn, NY 11201-3022 - Phone
- (704) 536-2958
- NPI assigned
- Nov 8, 2018
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
147 Prince St
Brooklyn, NY 11201-3022
Mailing address
147 Prince St
Brooklyn, NY 11201-3022
Phone (718) 536-2958
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cisaza@branchoutbh.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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1114495025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 PRINCE ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112013022",
"telephone_number": "718-536-2958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 PRINCE ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112013022",
"telephone_number": "704-536-2958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISAZA",
"first_name": "CAMILO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-08",
"last_updated": "2021-09-27",
"certification_date": "2021-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "S",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cisaza@branchoutbh.com",
"affiliation": "N",
"address_1": "147 Prince St",
"city": "Brooklyn",
"state": "NY",
"country_code": "US",
"postal_code": "112013022",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.