Nickelis Vincent

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

34590 County Line Rd Ste 7
Yucaipa, CA 92399-5398

Phone

(909) 795-4255

NPI assigned

Apr 10, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523318400000",
    "number": "1831696301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411 GRANDE VISTA PKWY APT 210",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035532",
            "telephone_number": "951-751-4794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34590 COUNTY LINE RD STE 7",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923995398",
            "telephone_number": "909-795-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "NICKELIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-10",
        "last_updated": "2018-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Crystal Amanda Wade
• Tiffany Wagner, PPS

• Behavior Technician in Yucaipa, CA
• Providers in Yucaipa, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; 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.