Individual provider Active NPI

Kennedy Simon

  • Behavior Technician
  • San Diego, CA
National Provider Identifier
1124535265
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
7090 Miratech Dr
San Diego, CA 92121
Phone
(949) 748-8571
NPI assigned
Jan 10, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 2, 2019

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 Primary

Addresses

Primary practice location

7090 Miratech Dr
San Diego, CA 92121

Mailing address

7090 Miratech Dr
San Diego, CA 92121-3109
Phone (949) 748-8571

Other practice location 1

2750 E Washington Blvd Ste 230
Pasadena, CA 91107-1449
Phone (626) 296-8900

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": "1515542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556755200000",
    "number": "1124535265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7090 MIRATECH DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213109",
            "telephone_number": "949-748-8571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7090 MIRATECH DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92121",
            "telephone_number": "949-748-8571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2750 E Washington Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911071449",
            "country_code": "US",
            "telephone_number": "626-296-8900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "KENNEDY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-10",
        "last_updated": "2019-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; 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.