Active NPI
Jessie Mambi Perrin
- Behavior Technician
- San Bernardino, CA
National Provider Identifier
1467136283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- Y2474252
- Practice address
- 732 Carnegie Dr Ste 100
San Bernardino, CA 92408-3589 - Phone
- (909) 490-5861
- NPI assigned
- Jun 12, 2023
- 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 | Y2474252 | CA | Primary |
Addresses
Primary practice location
732 Carnegie Dr Ste 100
San Bernardino, CA 92408-3589
Mailing address
5850 Granite Pkwy Ste 600
Plano, TX 75024-6753
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 |
|---|---|---|---|
| Y2474252 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686528000000",
"number": "1467136283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5850 GRANITE PKWY STE 600",
"city": "PLANO",
"state": "TX",
"postal_code": "750246753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "732 CARNEGIE DR STE 100",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924083589",
"telephone_number": "909-490-5861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRIN",
"first_name": "JESSIE",
"middle_name": "MAMBI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-12",
"last_updated": "2023-06-12",
"certification_date": "2023-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "Y2474252",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.