Daniel Benedict Owen Blackburn

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1300 Ethan Way, St 175
Sacramento, CA 95825

Phone

(916) 519-2350

NPI assigned

Jan 22, 2021

Last updated

Jan 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1611273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1194315168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399318",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941399318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ETHAN WAY, ST 175",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95825",
            "telephone_number": "916-519-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "DANIEL",
        "middle_name": "BENEDICT OWEN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-22",
        "last_updated": "2021-01-22",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "9471274",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Black, MD
• Hugh B Black, MD
• Lehman Ernest Black III, MD
• Rodney Wayne Black
• Shira Black
• Gertrude R. Blackburn
• Kaitlyn Jo Anne Blackburn
• Martha Louise Blackburn
• Walter Lee Blackburn, D.O.
• Dawn M Blacker, PH.D.

• Behavior Technician in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Behavior Technician in California

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

Verify at the official NPI Registry.