Active NPI
Juan Luis Cordova
- Driver
- El Centro, CA
National Provider Identifier
1043704034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- F4704795
- Practice address
- 1480 S Imperial Ave
El Centro, CA 92243-4200 - Phone
- (760) 455-1706
- NPI assigned
- Jun 21, 2018
- Last updated
- Jun 21, 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 |
|---|---|---|---|---|
| Driver | 172A00000X | F4704795 | CA | Primary |
Addresses
Primary practice location
1480 S Imperial Ave
El Centro, CA 92243-4200
Mailing address
1480 S Imperial Ave
El Centro, CA 92243-4200
Phone (760) 455-1706
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F4704795 | Other | CA | CALIFORNIA ID |
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 |
|---|---|---|---|
| F4704795 | CA | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safety Medical Transport Inc | Driver | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Driver
- El Centro, CA
- NPI 1942794938
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529539200000",
"number": "1043704034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1480 S IMPERIAL AVE",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922434200",
"telephone_number": "760-455-1706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1480 S IMPERIAL AVE",
"city": "EL CENTRO",
"state": "CA",
"postal_code": "922434200",
"telephone_number": "760-455-1706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDOVA",
"first_name": "JUAN",
"middle_name": "LUIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-21",
"last_updated": "2018-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "CA",
"license": "F4704795",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA ID",
"identifier": "F4704795",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Centro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.