NPI |
1992778864 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider Last Name Legal Name |
BLICKER |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
ILENA |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Middle Name |
JOYCE |
The middle name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
DR. |
The middle name of the provider, if the provider
is an individual. |
Provider Credential Text |
M.D. |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider First Line Business Practice Location Address |
435 ARDEN AVE |
The first 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 Second Line Business Practice Location Address |
SUITE 540 |
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 Business Practice Location Address City Name |
GLENDALE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CA |
The other abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Business Practice Location Address Postal Code |
912031130 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The first 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 Business Practice Location Address Telephone Number |
8182401677 |
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 Business Practice Location Address Fax Number |
8182400147 |
The city name in the location address of the provider being identified. |
Provider Enumeration Date |
2/9/2006 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
7/8/2007 |
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 Gender Code |
F |
The country code in the location address of the provider being identified. |
Healthcare Provider Taxonomy Code 1 |
2084N0400X |
The telephone number associated with the location address of the provider being identified. |
Provider License Number 1 |
G19424 |
The fax number associated with the location
address of the provider being identified. |
Provider License Number State Code 1 |
CA |
The date the provider was assigned a unique identifier (assigned an NPI). |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The date that a record was last updated or changed. |
Other Provider Identifier 1 |
00G194240 |
The code designating the provider’s gender if the provider is a person. |
Other Provider Identifier Type Code 1 |
05 |
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. |
Other Provider Identifier State 1 |
CA |
|
Is Sole Proprietor |
X |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |