Individual provider Active NPI

Eden Rae Jeffers

  • Assistant Behavior Analyst
  • San Diego, CA
National Provider Identifier
1548071715
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assistant Behavior AnalystTaxonomy code 106E00000X
Practice address
10264 Waddell Cir
San Diego, CA 92124-2934
Phone
(931) 449-3891
Fax
(833) 515-2618
NPI assigned
Jan 16, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assistant Behavior Analyst 106E00000X Primary

Addresses

Primary practice location

10264 Waddell Cir
San Diego, CA 92124-2934

Mailing address

220 Lakeview Cir
Tennessee Ridge, TN 37178-5106
Phone (931) 401-6646

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": "1736985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1548071715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 LAKEVIEW CIR",
            "city": "TENNESSEE RIDGE",
            "state": "TN",
            "postal_code": "371785106",
            "telephone_number": "931-401-6646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10264 WADDELL CIR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921242934",
            "telephone_number": "931-449-3891",
            "fax_number": "833-515-2618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERS",
        "first_name": "EDEN",
        "middle_name": "RAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.