NPI |
1356492060 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
ROKAW |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
JOSHUA |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
A |
The middle name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
DR. |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Provider Credential Text |
M.D. |
The city name in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
15211 VANOWEN ST |
The State code in the location of the provider
being identified. |
Provider Second Line Business Practice Location Address |
STE 100 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address City Name |
VAN NUYS |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CA |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
91405 |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Telephone Number |
8187781920 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Fax Number |
8187878804 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Enumeration Date |
1/16/2007 |
The first name of the authorized official. |
Last Update Date |
5/26/2023 |
The middle name of the authorized official. |
Provider Gender Code |
M |
The title or position of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
207R00000X |
The 10-position telephone number of the authorized official. |
Provider License Number 1 |
G59641 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
CA |
|
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
207RE0101X |
|
Provider License Number 2 |
G59641 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Provider License Number State Code 2 |
CA |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Is Sole Proprietor |
N |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
NPI Certification Date |
5/26/2023 |
|