Active NPI
Ivan Graciano, SURGICAL ASSISTANT
- Surgical Assistant
- Yuma, AZ
National Provider Identifier
1013418342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- R16-0201A
- Practice address
- 2911 S 8TH Ave
Yuma, AZ 85364-8000 - Phone
- (928) 783-3050
- Fax
- (928) 783-3050
- NPI assigned
- Feb 22, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | R16-0201A | AZ | Primary |
Addresses
Primary practice location
2911 S 8TH Ave
Yuma, AZ 85364-8000
Mailing address
2911 S 8TH Ave
Yuma, AZ 85364-8000
Phone (928) 783-3050
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R16-0201A | AZ | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519257600000",
"number": "1013418342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2911 S 8TH AVE",
"city": "YUMA",
"state": "AZ",
"postal_code": "853648000",
"telephone_number": "928-783-3050",
"fax_number": "928-783-3050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2911 S 8TH AVE",
"city": "YUMA",
"state": "AZ",
"postal_code": "853648000",
"telephone_number": "928-783-3050",
"fax_number": "928-783-3050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACIANO",
"first_name": "IVAN",
"credential": "SURGICAL ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-22",
"last_updated": "2018-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "AZ",
"license": "R16-0201A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.