Active NPI
Marissa E Evangelisa
- Behavior Analyst
- Union City, CA
National Provider Identifier
1760948384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 4512 Mackinaw St
Union City, CA 94587-5920 - Phone
- (510) 364-6265
- NPI assigned
- Feb 19, 2019
- Sex
- Female
- 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 Analyst | 103K00000X | CA | Primary |
Addresses
Primary practice location
4512 Mackinaw St
Union City, CA 94587-5920
Mailing address
4512 Mackinaw St
Union City, CA 94587-5920
Phone (510) 364-6265
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0469578 | Other | KAISER |
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": "1550534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550534400000",
"number": "1760948384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4512 MACKINAW ST",
"city": "UNION CITY",
"state": "CA",
"postal_code": "945875920",
"telephone_number": "510-364-6265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4512 MACKINAW ST",
"city": "UNION CITY",
"state": "CA",
"postal_code": "945875920",
"telephone_number": "510-364-6265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANGELISA",
"first_name": "MARISSA",
"middle_name": "E",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-19",
"last_updated": "2019-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER",
"identifier": "0469578",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Union City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.