Active NPI
Andrew Sirivarerattana
- Behavior Technician
- Elk Grove, CA
National Provider Identifier
1205613015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2368 Maritime Dr
Elk Grove, CA 95758-3652 - Phone
- (916) 676-0488
- NPI assigned
- Sep 14, 2023
- 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
2368 Maritime Dr
Elk Grove, CA 95758-3652
Mailing address
115 Creekside Cir
Sacramento, CA 95823-6706
Phone (916) 513-9317
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": "1694649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694649600000",
"number": "1205613015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 CREEKSIDE CIR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958236706",
"telephone_number": "916-513-9317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2368 MARITIME DR",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957583652",
"telephone_number": "916-676-0488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIRIVARERATTANA",
"first_name": "ANDREW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-14",
"last_updated": "2023-09-14",
"certification_date": "2023-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.