Nashira Yvette Funn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28168 Issued in CA

Practice address

3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369

Phone

(909) 425-7000

NPI assigned

Nov 16, 2007

Last updated

Nov 8, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Nashira Yvette Clark Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1023299203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 E. HIGHLAND AVENUE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "92369",
            "telephone_number": "909-425-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 E. HIGHLAND AVENUE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "92369",
            "telephone_number": "909-425-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNN",
        "first_name": "NASHIRA",
        "middle_name": "YVETTE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-16",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "28168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NASHIRA",
            "last_name": "CLARK",
            "middle_name": "YVETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Noemi Flores
• Carolyn Boosalis Foley, PH.D.
• Ron Foo, MD
• Ishea Monique Fort, LCSW
• Troy Steven Freimuth, PSY. D.
• Laura Gaitan
• Betsy E. Galicia
• Nazem Ghobrial, M.D.
• Virginia J Gibialante, LCSW
• Julius Gulawaiz Gill, PMHNP-BC

• Clinical Social Worker in Patton, CA
• Providers in Patton, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.