Ernesto Alexander Bedolla, N/A

Key facts

NPI

1386410652

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

License

Y1601235 (CA)

Practice address

21997 Avenue 176
Porterville, CA 93257-9272

Phone

(559) 542-8088

NPI assigned

Nov 28, 2023

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 28, 2023.

{
    "created_epoch": "1701129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1386410652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21997 AVENUE 176",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932579272",
            "telephone_number": "559-542-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21997 AVENUE 176",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932579272",
            "telephone_number": "559-542-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDOLLA",
        "first_name": "ERNESTO",
        "middle_name": "ALEXANDER",
        "credential": "N/A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-28",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "Y1601235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Porterville, CA · Behavior Technician in California