Active NPI
Danielle Wagoner, MA, BCBA
- Behavior Analyst
- Hermosa Beach, CA
National Provider Identifier
1508396359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-19-36951
- Practice address
- 2447 Pacific Coast Hwy Ste 111
Hermosa Beach, CA 90254-2743 - Phone
- (310) 374-3300
- NPI assigned
- Jun 14, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-19-36951 | CA | Primary |
| Behavior Technician | 106S00000X | 903211628 | CA |
Addresses
Primary practice location
2447 Pacific Coast Hwy Ste 111
Hermosa Beach, CA 90254-2743
Mailing address
2447 Pacific Coast Hwy Ste 111
Hermosa Beach, CA 90254-2743
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 903211628 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560729600000",
"number": "1508396359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2447 PACIFIC COAST HWY STE 111",
"city": "HERMOSA BEACH",
"state": "CA",
"postal_code": "902542743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2447 PACIFIC COAST HWY STE 111",
"city": "HERMOSA BEACH",
"state": "CA",
"postal_code": "902542743",
"telephone_number": "310-374-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "DANIELLE",
"credential": "MA, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-14",
"last_updated": "2019-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "1-19-36951",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "903211628",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermosa Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.