Active NPI
Jorge L Bautista
- Behavior Analyst
- Pasadena, CA
National Provider Identifier
1679147649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 106E00000X
- Practice address
- 200 E del Mar Blvd Ste 112
Pasadena, CA 91105-2552 - Phone
- (818) 937-0882
- Fax
- (818) 937-0883
- NPI assigned
- May 14, 2021
- 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 Analyst | 103K00000X | 106E00000X | CA | Primary |
Addresses
Primary practice location
200 E del Mar Blvd Ste 112
Pasadena, CA 91105-2552
Mailing address
200 E del Mar Blvd Ste 112
Pasadena, CA 91105-2552
Phone (818) 937-0882
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 |
|---|---|---|---|
| 106E00000X | CA | MD | Community/Behavioral Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664928000000",
"number": "1679147649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E DEL MAR BLVD STE 112",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052552",
"telephone_number": "818-937-0882",
"fax_number": "818-937-0883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E DEL MAR BLVD STE 112",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052552",
"telephone_number": "818-937-0882",
"fax_number": "818-937-0883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA",
"first_name": "JORGE",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-14",
"last_updated": "2022-10-05",
"certification_date": "2022-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": "106E00000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.