Active NPI
Renee Petersen
- Behavior Analyst
- La Quinta, CA
National Provider Identifier
1992399117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 79349 Calle Prospero
La Quinta, CA 92253-8560 - Phone
- (951) 296-8930
- NPI assigned
- Feb 28, 2021
- 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 Analyst | 103K00000X | Primary |
Addresses
Primary practice location
79349 Calle Prospero
La Quinta, CA 92253-8560
Mailing address
79349 Calle Prospero
La Quinta, CA 92253-8560
Phone (951) 296-8930
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614470400000",
"number": "1992399117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "79349 CALLE PROSPERO",
"city": "LA QUINTA",
"state": "CA",
"postal_code": "922538560",
"telephone_number": "951-296-8930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "79349 CALLE PROSPERO",
"city": "LA QUINTA",
"state": "CA",
"postal_code": "922538560",
"telephone_number": "951-296-8930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "RENEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-28",
"last_updated": "2021-02-28",
"certification_date": "2021-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Quinta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.