Active NPI
Nissa-Belle Vidal
- Behavior Analyst
- Huntington Beach, CA
National Provider Identifier
1215426960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-19-39870
- Practice address
- 4952 Warner Ave
Huntington Beach, CA 92649-4479 - Phone
- (714) 587-9007
- NPI assigned
- May 8, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 17-30402 | CA | |
| Behavior Analyst | 103K00000X | 1-19-39870 | CA | Primary |
Addresses
Primary practice location
4952 Warner Ave
Huntington Beach, CA 92649-4479
Mailing address
848 Reyana Way
Perris, CA 92571-5115
Phone (951) 970-2651
Other practice location 1
2529 24th St
San Francisco, CA 94110-3508
Phone (650) 260-4670
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17-30402 | CA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Positive Pathways LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- San Francisco, CA
- NPI 1336568344
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657152000000",
"number": "1215426960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "848 REYANA WAY",
"city": "PERRIS",
"state": "CA",
"postal_code": "925715115",
"telephone_number": "951-970-2651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4952 WARNER AVE",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926494479",
"telephone_number": "714-587-9007"
}
],
"practiceLocations": [
{
"address_1": "2529 24th St",
"address_purpose": "LOCATION",
"city": "San Francisco",
"state": "CA",
"postal_code": "941103508",
"country_code": "US",
"telephone_number": "650-260-4670",
"fax_number": "415-520-6530",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VIDAL",
"first_name": "NISSA-BELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-08",
"last_updated": "2022-07-07",
"certification_date": "2022-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "17-30402",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-19-39870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.