Healthcare Provider Details

I. General information

NPI: 1073446191
Provider Name (Legal Business Name): BLUESPRIG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 PARK AVE
SAN JOSE CA
95126-1629
US

IV. Provider business mailing address

1835 PARK AVE
SAN JOSE CA
95126-1629
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-0805
  • Fax:
Mailing address:
  • Phone: 408-885-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ANADELY RODRIGUEZ-MACHUCA
Title or Position: BEHAVIOR TECHNICIAN
Credential:
Phone: 805-863-2774