Eileen Caceres – Behavior Analyst in Tarzana, CA

Key facts

NPI: 1568031599
Entity type: Individual (NPI type 1)
Primary specialty: Behavior Analyst 103K00000X
License: 1-15-18352
Practice address: 5530 Corbin Ave Ste 221
Tarzana, CA 91356-6095
Phone: (818) 600-8758
Fax: (853) 728-0328
NPI assigned: Jun 23, 2021
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Behavior Analyst	103K00000X	1-15-18352		Yes

Addresses

Primary practice location

5530 Corbin Ave Ste 221
Tarzana, CA 91356-6095

Mailing address

5530 Corbin Ave Ste 221
Tarzana, CA 91356-6095
Phone (818) 600-8758

Other identifiers

Identifier	Type	State	Issuer
0	Medicaid	CA

Electronic endpoints

Type	Endpoint	Use	Affiliation
CONNECT URL	www.fmbtagency.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 23, 2021.

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1568031599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5530 CORBIN AVE STE 221",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913566095",
            "telephone_number": "818-600-8758",
            "fax_number": "853-728-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5530 CORBIN AVE STE 221",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913566095",
            "telephone_number": "818-600-8758",
            "fax_number": "853-728-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACERES",
        "first_name": "EILEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-15-18352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.fmbtagency.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "5530 Corbin Ave Ste 221",
            "city": "Tarzana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913566095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tarzana, CA

All providers in Tarzana, CA · Behavior Analyst in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.