Alejandra Jacqueline Matadama

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

Y4840416 Issued in CA

Practice address

12437 Lewis St Ste 100
Garden Grove, CA 92840-4651

Phone

(714) 202-0118

NPI assigned

Aug 25, 2021

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

State licenses

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1578230660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13634 LEMOLI AVE",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902507722",
            "telephone_number": "310-702-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12437 LEWIS ST STE 100",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404651",
            "telephone_number": "714-202-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATADAMA",
        "first_name": "ALEJANDRA",
        "middle_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "Y4840416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Technician in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.