Active NPI
Andrea Lisa Acevedo
- Behavior Analyst
- San Bernardino, CA
National Provider Identifier
1275394348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-23-67188
- Practice address
- 18030 Deerberry Way
San Bernardino
San Bernardino, CA 92407 - Phone
- (909) 996-8378
- NPI assigned
- Jan 17, 2024
- 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 Analyst | 103K00000X | 1-23-67188 | CA | Primary |
Addresses
Primary practice location
18030 Deerberry Way
San Bernardino
San Bernardino, CA 92407
Mailing address
18030 Deerberry Way
San Bernardino
San Bernardino, CA 92407
Phone (909) 996-8378
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": "1705449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705449600000",
"number": "1275394348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18030 DEERBERRY WAY",
"address_2": "SAN BERNARDINO",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "92407",
"telephone_number": "909-996-8378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18030 DEERBERRY WAY",
"address_2": "SAN BERNARDINO",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "92407",
"telephone_number": "909-996-8378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACEVEDO",
"first_name": "ANDREA",
"middle_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-17",
"last_updated": "2024-01-17",
"certification_date": "2024-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-23-67188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.