Active NPI
Coleman Luis Fresquez
- Behavior Technician
- Waterford, MI
National Provider Identifier
1124594130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 955 Campus Dr N
Waterford, MI 48328-2754 - Phone
- (248) 475-6300
- NPI assigned
- Oct 17, 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
955 Campus Dr N
Waterford, MI 48328-2754
Mailing address
9240 Steephollow Dr
White Lake, MI 48386-2068
Phone (248) 698-7730
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": "1539734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539734400000",
"number": "1124594130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9240 STEEPHOLLOW DR",
"city": "WHITE LAKE",
"state": "MI",
"postal_code": "483862068",
"telephone_number": "248-698-7730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "955 CAMPUS DR N",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483282754",
"telephone_number": "248-475-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRESQUEZ",
"first_name": "COLEMAN",
"middle_name": "LUIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-17",
"last_updated": "2018-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.