Active NPI
Alia Victoria Jackson
- Behavior Technician
- San Diego, CA
National Provider Identifier
1396471553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB804667
- Practice address
- 7592 Metropolitan Dr Ste 404
San Diego, CA 92108-4428 - Phone
- (619) 376-6653
- NPI assigned
- Jul 28, 2022
- 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 | BACB804667 | CA | Primary |
Addresses
Primary practice location
7592 Metropolitan Dr Ste 404
San Diego, CA 92108-4428
Mailing address
2725 W Canyon Ave Apt 138
San Diego, CA 92123-4687
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 |
|---|---|---|---|
| BACB804667 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658966400000",
"number": "1396471553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2725 W CANYON AVE APT 138",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7592 METROPOLITAN DR STE 404",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921084428",
"telephone_number": "619-376-6653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALIA",
"middle_name": "VICTORIA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-28",
"last_updated": "2022-07-28",
"certification_date": "2022-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "BACB804667",
"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 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.