Mario Hernan Tamayo Jr., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-17-25948 Issued in CO

Practice address

23502 Lyons Ave.
Suite 304a
Valencia, CA 91321

Phone

(661) 702-0166

Fax

(661) 702-0169

NPI assigned

May 14, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499299200000",
    "number": "1134411721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23502 LYONS AVENUE",
            "address_2": "SUITE 304A",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "91321",
            "telephone_number": "661-702-0166",
            "fax_number": "661-702-0169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23502 LYONS AVE.",
            "address_2": "SUITE 304A",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "91321",
            "telephone_number": "661-702-0166",
            "fax_number": "661-702-0169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMAYO",
        "first_name": "MARIO",
        "middle_name": "HERNAN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-14",
        "last_updated": "2017-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "0-06-2126",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-17-25948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCABA",
            "identifier": "0-06-2126",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA",
            "identifier": "1-17-25948",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Valencia, CA
• Providers in Valencia, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2017; 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.