Individual provider Active NPI

Lisa Heitzler, BCBA

  • Behavior Analyst
  • Rancho Cordova, CA
National Provider Identifier
1477899367
Registry record updated Dec 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
3195 Zinfandel Dr
Building G, Suite 21
Rancho Cordova, CA 95670-6376
Phone
(916) 812-9474
NPI assigned
Dec 20, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

3195 Zinfandel Dr
Building G, Suite 21
Rancho Cordova, CA 95670-6376

Mailing address

3195 Zinfandel Dr
Building G, Suite 21
Rancho Cordova, CA 95670-6376

Other identifiers 1

IdentifierTypeStateIssuer
1-09-5552OtherCABEHAVIOR ANALYST CERTIFICATION BOARD

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

Practice roles

OrganizationSpecialtyStatusNew patients
Square One Behavior Analyst Past Accepting new patients
Montessori Autism Programs & Services, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1355961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355961600000",
    "number": "1477899367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3195 ZINFANDEL DR",
            "address_2": "BUILDING G, SUITE 21",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956706376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3195 ZINFANDEL DR",
            "address_2": "BUILDING G, SUITE 21",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956706376",
            "telephone_number": "916-812-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEITZLER",
        "first_name": "LISA",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-20",
        "last_updated": "2012-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIOR ANALYST CERTIFICATION BOARD",
            "identifier": "1-09-5552",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cordova, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; 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.