Active NPI
Quordric C Gibson
- Behavior Technician
- Sacramento, CA
National Provider Identifier
1689214835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 610 Bercut Dr
Sacramento, CA 95811-0115 - Phone
- (916) 443-2479
- NPI assigned
- Jan 15, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
610 Bercut Dr
Sacramento, CA 95811-0115
Mailing address
8425 Coeburn St
Sacramento, CA 95823-7204
Phone (601) 918-3055
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": "1579046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579046400000",
"number": "1689214835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8425 COEBURN ST",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958237204",
"telephone_number": "601-918-3055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 BERCUT DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958110115",
"telephone_number": "916-443-2479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "QUORDRIC",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-15",
"last_updated": "2020-01-15",
"certification_date": "2020-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.