Individual provider Active NPI

Anthony Jauregui

  • Licensed Psychiatric Technician
  • Fresno, CA
National Provider Identifier
1609411677
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Psychiatric TechnicianTaxonomy code 167G00000X
License
41474 Issued in CA
Practice address
496 S Barton Ave
Fresno, CA 93702-2985
Phone
(559) 860-4422
NPI assigned
Nov 13, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Psychiatric Technician 167G00000X 41474 CA Primary

Addresses

Primary practice location

496 S Barton Ave
Fresno, CA 93702-2985

Mailing address

3433 W Shaw Ave Ste 102
Fresno, CA 93711-3229
Phone (559) 558-4051

Other practice location 1

4411 E Kings Canyon Rd
Fresno, CA 93702-3604
Phone (559) 453-1008

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

State licenses

LicenseStateTypeSpecialty
41474CAMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1609411677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 W SHAW AVE STE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113229",
            "telephone_number": "559-558-4051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 S BARTON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937022985",
            "telephone_number": "559-860-4422"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4411 E Kings Canyon Rd",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937023604",
            "country_code": "US",
            "telephone_number": "559-453-1008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAUREGUI",
        "first_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-13",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "41474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.