Paul Portis, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-19-97226 Issued in CA

Practice address

5393 Lupine Ave
Twentynine Palms, CA 92277-1471

Phone

(442) 241-4299

NPI assigned

Aug 27, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1366090912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5393 LUPINE AVE",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922771471",
            "telephone_number": "442-241-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5393 LUPINE AVE",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922771471",
            "telephone_number": "442-241-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTIS",
        "first_name": "PAUL",
        "credential": "RBT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-27",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "RBT-19-97226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "TwentyninePalms",
            "affiliation": "N",
            "endpointDescription": "Private",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5393 Lupine Ave",
            "city": "Twentynine Palms",
            "state": "CA",
            "country_code": "US",
            "postal_code": "922771471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Technician in Twentynine Palms, CA
• Providers in Twentynine Palms, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.

Verify at the official NPI Registry.