Active NPI
Wallace Conrad Dixon Jr.
- Behavior Analyst
- San Jose, CA
National Provider Identifier
1417228461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 801 S Winchester Blvd Apt 5105
San Jose, CA 95128-2976 - Phone
- (510) 253-6769
- NPI assigned
- Jan 23, 2012
- Sex
- Male
- Sole proprietor
- Yes
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 Analyst | 103K00000X | Primary |
Addresses
Primary practice location
801 S Winchester Blvd Apt 5105
San Jose, CA 95128-2976
Mailing address
801 S Winchester Blvd Apt 5105
San Jose, CA 95128-2976
Phone (510) 253-6769
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": "1327276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327276800000",
"number": "1417228461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 S WINCHESTER BLVD APT 5105",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282976",
"telephone_number": "510-253-6769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S WINCHESTER BLVD APT 5105",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282976",
"telephone_number": "510-253-6769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIXON",
"first_name": "WALLACE",
"middle_name": "CONRAD",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-23",
"last_updated": "2012-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.