Active NPI
Brenna R Koenig
- Behavior Technician
- San Dimas, CA
National Provider Identifier
1346804200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 677 Cliffside Dr
San Dimas, CA 91773-2957 - Phone
- (626) 345-6455
- NPI assigned
- Apr 25, 2019
- 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
677 Cliffside Dr
San Dimas, CA 91773-2957
Mailing address
21600 Oxnard St Ste 1800
Woodland Hills, CA 91367-7807
Phone (818) 345-2345
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": "1556150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556150400000",
"number": "1346804200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21600 OXNARD ST STE 1800",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913677807",
"telephone_number": "818-345-2345",
"fax_number": "000-000-0000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "677 CLIFFSIDE DR",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917732957",
"telephone_number": "626-345-6455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOENIG",
"first_name": "BRENNA",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-25",
"last_updated": "2019-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Dimas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.