Individual provider Active NPI

Vivian Charbel Boukhalil

  • Behavior Analyst
  • Yorba Linda, CA
National Provider Identifier
1508635186
Registry record updated Dec 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
28620 Evening Breeze Dr
Yorba Linda, CA 92887-6410
Phone
(657) 549-0489
NPI assigned
Dec 25, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 25, 2023

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

28620 Evening Breeze Dr
Yorba Linda, CA 92887-6410

Mailing address

713 W Commonwealth Ave
Fullerton, CA 92832-1612
Phone (657) 549-0489

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

NPI Registry JSON

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

{
    "created_epoch": "1703462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703462400000",
    "number": "1508635186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 W COMMONWEALTH AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928321612",
            "telephone_number": "657-549-0489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28620 EVENING BREEZE DR",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928876410",
            "telephone_number": "657-549-0489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUKHALIL",
        "first_name": "VIVIAN",
        "middle_name": "CHARBEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-25",
        "last_updated": "2023-12-25",
        "certification_date": "2023-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yorba Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 2023; 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.