Active NPI
Ezekiel Jackson
- Behavior Technician
- Gardena, CA
National Provider Identifier
1811896038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 879 W 190TH St Ste 1000
Gardena, CA 90248-4255 - Phone
- (443) 430-7570
- NPI assigned
- Nov 3, 2026
- Last updated
- Nov 3, 2026
- 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 Technician | 106S00000X | Primary |
Addresses
Primary practice location
879 W 190TH St Ste 1000
Gardena, CA 90248-4255
Mailing address
1550 2ND Ave Apt 8
Los Angeles, CA 90019-4542
Phone (617) 480-3298
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1793664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1793664000000",
"number": "1811896038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 2ND AVE APT 8",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900194542",
"telephone_number": "617-480-3298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "879 W 190TH ST STE 1000",
"city": "GARDENA",
"state": "CA",
"postal_code": "902484255",
"telephone_number": "443-430-7570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "EZEKIEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-11-03",
"last_updated": "2026-11-03",
"certification_date": "2026-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.