Active NPI
Paula Christensen Jackson
- Behavior Technician
- Fremont, CA
National Provider Identifier
1235804659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 46-1305562
- Practice address
- 39210 State St Ste 204
Fremont, CA 94538-1456 - Phone
- (510) 894-4135
- NPI assigned
- Aug 9, 2021
- Sex
- Female
- 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 | 46-1305562 | CA | Primary |
Addresses
Primary practice location
39210 State St Ste 204
Fremont, CA 94538-1456
Mailing address
21076 Grenola Dr
Cupertino, CA 95014-1624
Phone (512) 571-0680
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 |
|---|---|---|---|
| 46-1305562 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1235804659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21076 GRENOLA DR",
"city": "CUPERTINO",
"state": "CA",
"postal_code": "950141624",
"telephone_number": "512-571-0680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39210 STATE ST STE 204",
"city": "FREMONT",
"state": "CA",
"postal_code": "945381456",
"telephone_number": "510-894-4135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PAULA",
"middle_name": "CHRISTENSEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-09",
"last_updated": "2021-08-09",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "46-1305562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.