Active NPI
Crystal Medrano Avila, BI
- Behavior Technician
- San Diego, CA
National Provider Identifier
1982118238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-17-42571
- Practice address
- 15373 Innovation Dr Ste 200
San Diego, CA 92128-3425 - Phone
- (858) 699-7579
- Fax
- (858) 726-6021
- NPI assigned
- Nov 23, 2017
- Sex
- Female
- Sole proprietor
- Yes
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-17-42571 | CA | Primary |
Addresses
Primary practice location
15373 Innovation Dr Ste 200
San Diego, CA 92128-3425
Mailing address
15373 Innovation Dr Ste 200
San Diego, CA 92128-3425
Phone (858) 699-7579
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RBT-17-42571 | Other | CA | RBT |
Other names 1
- Crystal Avila Medrano
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-17-42571 | CA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Verbal Behavior Associates | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- San Diego, CA
- NPI 1235543265
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511395200000",
"number": "1982118238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15373 INNOVATION DR STE 200",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921283425",
"telephone_number": "858-699-7579",
"fax_number": "858-726-6021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15373 INNOVATION DR STE 200",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921283425",
"telephone_number": "858-699-7579",
"fax_number": "858-726-6021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVILA",
"first_name": "CRYSTAL",
"middle_name": "MEDRANO",
"name_prefix": "Miss",
"credential": "BI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-23",
"last_updated": "2017-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "RBT-17-42571",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RBT",
"identifier": "RBT-17-42571",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CRYSTAL",
"last_name": "MEDRANO",
"middle_name": "AVILA",
"credential": "BI",
"code": "5",
"type": "Other Name"
}
]
}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 Nov 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.