Active NPI
Adam Moline
- Behavior Analyst
- Elk Grove, CA
National Provider Identifier
1588180152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 9355 E Stockton Blvd Ste 100
Elk Grove, CA 95624-9476 - Phone
- (916) 683-1109
- NPI assigned
- Aug 16, 2017
- Last updated
- Jul 8, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | CA | Primary | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
9355 E Stockton Blvd Ste 100
Elk Grove, CA 95624-9476
Mailing address
3601 Pacific Ave
Stockton, CA 95211-0110
Other practice location 1
405 E Pine St
Stockton, CA 95204-5522
Phone (209) 464-5519
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": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594166400000",
"number": "1588180152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 PACIFIC AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952110110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9355 E STOCKTON BLVD STE 100",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956249476",
"telephone_number": "916-683-1109"
}
],
"practiceLocations": [
{
"address_1": "405 E Pine St",
"address_purpose": "LOCATION",
"city": "Stockton",
"state": "CA",
"postal_code": "952045522",
"country_code": "US",
"telephone_number": "209-464-5519",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOLINE",
"first_name": "ADAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-16",
"last_updated": "2020-07-08",
"certification_date": "2020-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.