1336884071 NPI number — AMBER NICOLE NIXON BEHAVIOR TECHNICIAN

Table of content: AMBER NICOLE NIXON BEHAVIOR TECHNICIAN (NPI 1336884071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336884071 NPI number — AMBER NICOLE NIXON BEHAVIOR TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIXON
Provider First Name:
AMBER
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BEHAVIOR TECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336884071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11037 WARNER AVE # 339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-272-4292
Provider Business Mailing Address Fax Number:
714-596-6274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1174 CORNUCOPIA ST NW STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97304-3193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-273-4292
Provider Business Practice Location Address Fax Number:
714-596-6274
Provider Enumeration Date:
04/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , with the licence number:  ABA-IN-10209591 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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