Individual provider Active NPI

Jila Ghabeljoo

  • General Practice Registered Nurse
  • San Diego, CA
National Provider Identifier
1033604475
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
629423 Issued in CA
Practice address
12672 Carmel Country Rd Unit 49
San Diego, CA 92130-3180
Phone
(858) 380-7797
NPI assigned
Jun 28, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 629423 CA Primary

Addresses

Primary practice location

12672 Carmel Country Rd Unit 49
San Diego, CA 92130-3180

Mailing address

12672 Carmel Country Rd Unit 49
San Diego, CA 92130-3180
Phone (858) 380-7797

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

LicenseStateTypeSpecialty
629423CAMDGeneral Practice Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1033604475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12672 CARMEL COUNTRY RD UNIT 49",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303180",
            "telephone_number": "858-380-7797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12672 CARMEL COUNTRY RD UNIT 49",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303180",
            "telephone_number": "858-380-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHABELJOO",
        "first_name": "JILA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "629423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.

Verify at the official NPI Registry.