Active NPI
Craig Wilson
- Behavior Technician
- San Bernardino, CA
National Provider Identifier
1669034625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 25180 5TH St Apt 209
San Bernardino, CA 92410-5164 - Phone
- (909) 659-3048
- NPI assigned
- Jun 30, 2019
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
25180 5TH St Apt 209
San Bernardino, CA 92410-5164
Mailing address
25180 5TH St Apt 209
San Bernardino, CA 92410-5164
Phone (909) 659-3048
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": "1561852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561852800000",
"number": "1669034625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25180 5TH ST APT 209",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924105164",
"telephone_number": "909-659-3048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25180 5TH ST APT 209",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924105164",
"telephone_number": "909-659-3048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CRAIG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-30",
"last_updated": "2019-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.