NPI |
1720283419 |
The first name of the provider, if the provider
is an individual. |
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 |
LAROSA |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
MARIA |
The first name of the provider, if the provider
is an individual. |
Provider Middle Name |
M. |
The middle name of the provider, if the provider
is an individual. |
Provider Name Suffix Text |
II |
The city name in the location address of the provider being identified. |
Provider Credential Text |
MFT |
The State code in the location of the provider
being identified. |
Provider First Line Business Practice Location Address |
83844 HOPI AVE |
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 |
INDIO |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
922032638 |
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 Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
7609025908 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
6/20/2007 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
7/8/2007 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Gender Code |
F |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Taxonomy Code 1 |
106H00000X |
|
Provider License Number 1 |
34865 |
|
Provider License Number State Code 1 |
CA |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |