Active NPI
Indigo Davis
- Behavior Technician
- Rohnert Park, CA
National Provider Identifier
1336617430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 183 Avram Ave Apt 6
Rohnert Park, CA 94928-3142 - Phone
- (707) 834-0268
- NPI assigned
- Nov 6, 2018
- 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 | Primary |
Addresses
Primary practice location
183 Avram Ave Apt 6
Rohnert Park, CA 94928-3142
Mailing address
390 Union Blvd Ste 300
Lakewood, CO 80228-6514
Phone (303) 989-8172
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F4622534 | Other | CA | CA DRIVERS LICENSE |
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": "1541462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541462400000",
"number": "1336617430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "390 UNION BLVD STE 300",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802286514",
"telephone_number": "303-989-8172",
"fax_number": "303-984-4366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "183 AVRAM AVE APT 6",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949283142",
"telephone_number": "707-834-0268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "INDIGO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-06",
"last_updated": "2018-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA DRIVERS LICENSE",
"identifier": "F4622534",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.