Active NPI
Ethan Emery Phillips
- Behavior Technician
- San Diego, CA
National Provider Identifier
1851003370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-22-249254
- Practice address
- 2445 Truxtun Rd
San Diego, CA 92106-6153 - Phone
- (619) 633-2119
- NPI assigned
- Dec 15, 2022
- 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 | RBT-22-249254 | CA | Primary |
Addresses
Primary practice location
2445 Truxtun Rd
San Diego, CA 92106-6153
Mailing address
7521 Radenz Ave
San Diego, CA 92111-5820
Phone (559) 772-7372
Other practice location 1
7521 Radenz Ave
San Diego, CA 92111-5820
Phone (559) 772-7372
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 |
|---|---|---|---|
| RBT-22-249254 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1671062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671062400000",
"number": "1851003370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7521 RADENZ AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921115820",
"telephone_number": "559-772-7372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2445 TRUXTUN RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921066153",
"telephone_number": "619-633-2119"
}
],
"practiceLocations": [
{
"address_1": "7521 Radenz Ave",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921115820",
"country_code": "US",
"telephone_number": "559-772-7372",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHILLIPS",
"first_name": "ETHAN",
"middle_name": "EMERY",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-15",
"last_updated": "2022-12-15",
"certification_date": "2022-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "RBT-22-249254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.