Active NPI
Elizabeth J Rodriguez
- Behavior Technician
- Mountain Home, ID
National Provider Identifier
1659989754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- A0003962
- Practice address
- 4209 N 18TH East St
Mountain Home, ID 83647-5899 - Phone
- (208) 599-0944
- NPI assigned
- Jul 15, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | A0003962 | ID | Primary |
Addresses
Primary practice location
4209 N 18TH East St
Mountain Home, ID 83647-5899
Mailing address
4209 N 18TH E
Mountain Home, ID 83647-5899
Phone (208) 599-0944
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A0003962 | Medicaid | ID |
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
| License | State | Type | Specialty |
|---|---|---|---|
| A0003962 | ID | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594771200000",
"number": "1659989754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4209 N 18TH E",
"city": "MOUNTAIN HOME",
"state": "ID",
"postal_code": "836475899",
"telephone_number": "208-599-0944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4209 N 18TH EAST ST",
"city": "MOUNTAIN HOME",
"state": "ID",
"postal_code": "836475899",
"telephone_number": "208-599-0944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "ELIZABETH",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-15",
"last_updated": "2020-07-15",
"certification_date": "2020-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "ID",
"license": "A0003962",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A0003962",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.