Active NPI
Tera Evans
- Behavior Technician
- San Diego, CA
National Provider Identifier
1376224923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 23-2777758
- Practice address
- 5075 Shoreham PL Ste 115
San Diego, CA 92122-5927 - Phone
- (858) 272-2662
- Fax
- (858) 272-2661
- NPI assigned
- Jul 27, 2023
- 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 | 23-2777758 | CA | Primary |
Addresses
Primary practice location
5075 Shoreham PL Ste 115
San Diego, CA 92122-5927
Mailing address
6874 Sugar Pine CT
Chino, CA 91710-7409
Phone (909) 610-5981
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-2777758 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1376224923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6874 SUGAR PINE CT",
"city": "CHINO",
"state": "CA",
"postal_code": "917107409",
"telephone_number": "909-610-5981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5075 SHOREHAM PL STE 115",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921225927",
"telephone_number": "858-272-2662",
"fax_number": "858-272-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "TERA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-27",
"last_updated": "2023-07-27",
"certification_date": "2023-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "23-2777758",
"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 Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.