Individual provider Active NPI

Kayla R Juris

  • Behavior Technician
  • San Diego, CA
National Provider Identifier
1710578166
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
BACB646833 Issued in CA
Practice address
5075 Shoreham PL Ste 115
San Diego, CA 92122-5927
Phone
(507) 511-5921
Fax
(858) 272-2661
NPI assigned
Jan 28, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X BACB646833 CA Primary

Addresses

Primary practice location

5075 Shoreham PL Ste 115
San Diego, CA 92122-5927

Mailing address

2240 1/2 Grand Ave
San Diego, CA 92109-4757
Phone (570) 687-7158

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL gveracruz@ascaba.com Direct

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
BACB646833CAMDBehavior Technician

NPI Registry JSON

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

{
    "created_epoch": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1710578166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 1/2 GRAND AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921094757",
            "telephone_number": "570-687-7158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5075 SHOREHAM PL STE 115",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921225927",
            "telephone_number": "507-511-5921",
            "fax_number": "858-272-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURIS",
        "first_name": "KAYLA",
        "middle_name": "R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "BACB646833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "gveracruz@ascaba.com",
            "affiliation": "N",
            "endpointDescription": "Office Manager Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5075 Shoreham Pl Ste 115",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921225927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; 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.