Active NPI
Wayne Steven Wilson Jr.
- Behavior Technician
- Monrovia, CA
National Provider Identifier
1770161887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 612 S Myrtle Ave Ste 100
Monrovia, CA 91016-3406 - Phone
- (800) 465-3203
- NPI assigned
- Mar 30, 2021
- 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
612 S Myrtle Ave Ste 100
Monrovia, CA 91016-3406
Mailing address
3500 Iowa Ave Apt 412-a
Riverside, CA 92507-7208
Phone (310) 924-4859
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": "1617062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1770161887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 IOWA AVE APT 412-A",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925077208",
"telephone_number": "310-924-4859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 S MYRTLE AVE STE 100",
"city": "MONROVIA",
"state": "CA",
"postal_code": "910163406",
"telephone_number": "800-465-3203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "WAYNE",
"middle_name": "STEVEN",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-30",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monrovia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.