Active NPI
Gina Brooks
- Behavior Technician
- San Jose, CA
National Provider Identifier
1477025898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 00008146
- Practice address
- 4030 Moorpark Ave Ste 105
San Jose, CA 95117-1848 - Phone
- (669) 444-5980
- Fax
- (855) 568-2494
- NPI assigned
- Dec 24, 2018
- 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 | 00008146 | CA | Primary |
Addresses
Primary practice location
4030 Moorpark Ave Ste 105
San Jose, CA 95117-1848
Mailing address
18726 S Western Ave Ste 408
Gardena, CA 90248-3858
Phone (310) 856-0800
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 |
|---|---|---|---|
| 00008146 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545609600000",
"number": "1477025898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18726 S WESTERN AVE STE 408",
"city": "GARDENA",
"state": "CA",
"postal_code": "902483858",
"telephone_number": "310-856-0800",
"fax_number": "855-568-2494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4030 MOORPARK AVE STE 105",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951171848",
"telephone_number": "669-444-5980",
"fax_number": "855-568-2494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "GINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-24",
"last_updated": "2018-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "00008146",
"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 Dec 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.