Active NPI
Jolene Nguyen Pham
- Behavior Analyst
- Fullerton, CA
National Provider Identifier
1457814691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-23-70228
- Practice address
- 713 W Commonwealth Ave
Suite C
Fullerton, CA 92832 - Phone
- (714) 879-4274
- NPI assigned
- Apr 12, 2019
- Last updated
- Jan 11, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-23-70228 | CA | Primary |
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
713 W Commonwealth Ave
Suite C
Fullerton, CA 92832
Mailing address
713 W Commonwealth Ave
Suite C
Fullerton, CA 92832
Other practice location 1
1200 Concord Ave Ste 100
Concord, CA 94520-4969
Phone (510) 268-8120
Other practice location 2
1301 E Orangewood Ave
Anaheim, CA 92805-6807
Phone (800) 249-1266
Other practice location 3
1200 Concord Ave Ste 100
Concord, CA 94520-4969
Phone (510) 268-8120
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": "1555027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704931200000",
"number": "1457814691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "713 W COMMONWEALTH AVE",
"address_2": "SUITE C",
"city": "FULLERTON",
"state": "CA",
"postal_code": "92832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "713 W COMMONWEALTH AVE",
"address_2": "SUITE C",
"city": "FULLERTON",
"state": "CA",
"postal_code": "92832",
"telephone_number": "714-879-4274"
}
],
"practiceLocations": [
{
"address_1": "1200 Concord Ave Ste 100",
"address_purpose": "LOCATION",
"city": "Concord",
"state": "CA",
"postal_code": "945204969",
"country_code": "US",
"telephone_number": "510-268-8120",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1301 E Orangewood Ave",
"address_purpose": "LOCATION",
"city": "Anaheim",
"state": "CA",
"postal_code": "928056807",
"country_code": "US",
"telephone_number": "800-249-1266",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1200 Concord Ave Ste 100",
"address_purpose": "LOCATION",
"city": "Concord",
"state": "CA",
"postal_code": "945204969",
"country_code": "US",
"telephone_number": "510-268-8120",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHAM",
"first_name": "JOLENE",
"middle_name": "NGUYEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-12",
"last_updated": "2024-01-11",
"certification_date": "2024-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-23-70228",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.