Active NPI
Kimberly Fry
- Behavior Technician
- Azusa, CA
National Provider Identifier
1841910635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- C3299065
- Practice address
- 840 E Foothill Blvd SPC 71
Azusa, CA 91702-2610 - Phone
- (626) 890-2120
- NPI assigned
- Aug 31, 2022
- 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 Technician | 106S00000X | C3299065 | CA | Primary |
Addresses
Primary practice location
840 E Foothill Blvd SPC 71
Azusa, CA 91702-2610
Mailing address
99 Pasadena Ave Ste 10C
South Pasadena, CA 91030-6142
Phone (213) 607-4343
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C3299065 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1841910635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 PASADENA AVE STE 10C",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910306142",
"telephone_number": "213-607-4343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 E FOOTHILL BLVD SPC 71",
"city": "AZUSA",
"state": "CA",
"postal_code": "917022610",
"telephone_number": "626-890-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRY",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-31",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "C3299065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Azusa, CA
- Foothill Community Free Methodist Church (Foothill Counseling Center)
- Foothill Community Medical Corp. (San Rafael Community Medical Clinic)
- Erick F. Frances
- Lousine Frandjian
- Fratt Dental Corporation (Azusa Dental)
- Benjamin Fuller, ATC
- Juana Gaeta
- Jonathan Antonio Galdamez, RBT
- Victoria Galicia
- Anthony Gallina, CCBADC RRW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.