Individual provider Active NPI

Brianna Bautista

  • Behavior Technician
  • San Diego, CA
National Provider Identifier
1356946115
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
11650 Iberia PL Ste 130
San Diego, CA 92128-2431
Phone
(858) 264-5858
Fax
(858) 649-6012
NPI assigned
Dec 1, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X Primary

Addresses

Primary practice location

11650 Iberia PL Ste 130
San Diego, CA 92128-2431

Mailing address

8301 Mission Gorge Rd SPC 190
Santee, CA 92071-3588
Phone (619) 549-1162

Other practice location 1

400 W Ventura Blvd Ste 230
Camarillo, CA 93010-9142
Phone (858) 264-5858

Other practice location 2

9600 Center Ave Ste 160
Rancho Cucamonga, CA 91730-5838
Phone (858) 264-5858

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": "1606780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1356946115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8301 MISSION GORGE RD SPC 190",
            "city": "SANTEE",
            "state": "CA",
            "postal_code": "920713588",
            "telephone_number": "619-549-1162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11650 IBERIA PL STE 130",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282431",
            "telephone_number": "858-264-5858",
            "fax_number": "858-649-6012"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 W Ventura Blvd Ste 230",
            "address_purpose": "LOCATION",
            "city": "Camarillo",
            "state": "CA",
            "postal_code": "930109142",
            "country_code": "US",
            "telephone_number": "858-264-5858",
            "fax_number": "858-649-6012",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9600 Center Ave Ste 160",
            "address_purpose": "LOCATION",
            "city": "Rancho Cucamonga",
            "state": "CA",
            "postal_code": "917305838",
            "country_code": "US",
            "telephone_number": "858-264-5858",
            "fax_number": "858-649-6012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "BRIANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.