Individual provider Active NPI

Jacqueline Flores, BEHAVIOR TECHNICIAN

  • Behavior Technician
  • Santa Ana, CA
National Provider Identifier
1831769835
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
1901 Carnegie Ave Ste 1C
Santa Ana, CA 92705-5504
Phone
(800) 273-4292
Fax
(714) 596-6274
NPI assigned
Jun 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 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 Primary

Addresses

Primary practice location

1901 Carnegie Ave Ste 1C
Santa Ana, CA 92705-5504

Mailing address

11037 Warner Ave # 339
Fountain Valley, CA 92708-4007
Phone (800) 273-4292

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

Practice roles

OrganizationSpecialtyStatusNew patients
Footprints Behavior Interventions CurrentSince Jul 24, 2022 Accepting new patients
Footprints Behavioral Interventions, Inc. Behavior Technician CurrentSince Jul 4, 2021 Accepting new patients

Locations

11037 Warner Ave
#339
Fountain Valley, CA 92708
Phone (714) 848-8319

1901 Carnegie Ave
Ste 1C
Santa Ana, CA 92705
Phone (714) 848-8319

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1831769835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11037 WARNER AVE # 339",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084007",
            "telephone_number": "800-273-4292",
            "fax_number": "714-596-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 CARNEGIE AVE STE 1C",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927055504",
            "telephone_number": "800-273-4292",
            "fax_number": "714-596-6274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORES",
        "first_name": "JACQUELINE",
        "credential": "BEHAVIOR TECHNICIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

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

Verify at the official NPI Registry.