Jessica Gordillo, M.A., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-15-17926 Issued in CA

Practice address

21201 Victory Blvd Ste 205
Canoga Park, CA 91303-4056

Phone

(888) 428-3223

Fax

(323) 866-1881

NPI assigned

Apr 1, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Locations

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.

• Intercare Therapy Inc.

  • Community/Behavioral Health Agency
  • Las Vegas, NV
  • NPI 1164065892
  NPD

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1528453065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 WILSHIRE BLVD STE 300A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900103537",
            "telephone_number": "888-428-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21201 VICTORY BLVD STE 205",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913034056",
            "telephone_number": "888-428-3223",
            "fax_number": "323-866-1881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17609 Ventura Blvd",
            "address_2": "Suite 215",
            "address_purpose": "LOCATION",
            "city": "Encino",
            "state": "CA",
            "postal_code": "913163858",
            "country_code": "US",
            "telephone_number": "818-501-8352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDILLO",
        "first_name": "JESSICA",
        "credential": "M.A., BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-15-17926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Gonzalez
• Yolanda Gonzalez
• Good Faith Hospice and Palliative Care Inc
• Goodlife HHA, Inc
• Tetiana Gorbach
• Willie Gordon II
• Patrick Gorman
• Carisa Gotcher
• Jeremy Govoni
• William Gracey

• Behavior Analyst in Canoga Park, CA
• Providers in Canoga Park, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.