Kerubo Joann Chantell Isanda

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

5215 Edina Industrial Blvd Ste 200
Edina, MN 55439-2926

Phone

(310) 856-0800

NPI assigned

Jul 23, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1457189375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 EDINA INDUSTRIAL BLVD STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392926",
            "telephone_number": "310-856-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 EDINA INDUSTRIAL BLVD STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392926",
            "telephone_number": "310-856-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISANDA",
        "first_name": "KERUBO",
        "middle_name": "JOANN CHANTELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Technician in Edina, MN
• Providers in Edina, MN by specialty
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.