NPIMap

Individual provider Active NPI

Demetrius Hamala

  • Behavior Analyst
  • Stockton, CA
National Provider Identifier
1942701263
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-21-52469 Issued in CA
Practice address
3620 W Hammer LN
Stockton, CA 95219-5435
Phone
(209) 521-4791
Fax
(209) 521-4794
NPI assigned
Feb 22, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Behavior Analyst 103K00000X 1-21-52469 CA Primary

Addresses

Primary practice location

3620 W Hammer LN
Stockton, CA 95219-5435

Mailing address

3425 Coffee Rd Ste C2
Modesto, CA 95355-1582

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
Central Valley Autism Project, Inc. Behavior Analyst Past Accepting new patients
Kadiant, LLC Behavior Analyst Past Accepting new patients
Centra Medical Group, LLC Past Accepting new patients

Organizations & group practices 3

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": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633046400000",
    "number": "1942701263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 COFFEE RD STE C2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 W HAMMER LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952195435",
            "telephone_number": "209-521-4791",
            "fax_number": "209-521-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMALA",
        "first_name": "DEMETRIUS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-22",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-21-52469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.