Tiffany Rochelle Fagan, RBT

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

700251 Issued in CA

Practice address

2504 3Rd Ave
Merced, CA 95340-3010

Phone

(209) 720-9380

NPI assigned

Sep 15, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1477275477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3183",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953441183",
            "telephone_number": "209-535-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 3RD AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953403010",
            "telephone_number": "209-720-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "TIFFANY",
        "middle_name": "ROCHELLE",
        "credential": "RBT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": "CA",
            "license": "700251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RBT",
            "identifier": "700251",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "admin@lpways.com",
            "affiliation": "N",
            "endpointDescription": "admin@lpways.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2504 3rd Ave",
            "city": "Merced",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953403010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Evergreen Care Medical
• Angela Katherine Eversley, LVN
• Experience Health Care Services
• Kathryn Eyberg, LVN
• Ez Sleep Club, Inc.
• Randy Garrett Fagundes
• Albert Falley, LVN
• Family Clinic of Merced Medical Office Inc
• Family Practice Residency
• Juvenal Farias

• Assistant Behavior Analyst in Merced, CA
• Providers in Merced, CA by specialty
• Assistant Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; 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.