Stanley Serisola

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-53763 Issued in CA

Practice address

4700 Spring St Ste 180
La Mesa, CA 91942-0272

Phone

(619) 404-0839

NPI assigned

Feb 7, 2018

Last updated

Oct 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1508365370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216000 OXNARD ST",
            "address_2": "STE 1800",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913677807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 SPRING ST STE 180",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919420272",
            "telephone_number": "619-404-0839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15708 Pomerado Rd Ste 102N",
            "address_purpose": "LOCATION",
            "city": "Poway",
            "state": "CA",
            "postal_code": "920642035",
            "country_code": "US",
            "telephone_number": "858-746-5566 x2601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SERISOLA",
        "first_name": "STANLEY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-07",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-21-53763",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "D7435110",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.