Active NPI
Jacquene J Richardson
- Licensed Psychiatric Technician
- Los Angeles, CA
National Provider Identifier
1053699850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- PT36012
- Practice address
- 3875 S Western Ave
Los Angeles, CA 90062-1105 - Phone
- (323) 290-4373
- NPI assigned
- Jul 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT36012 | CA | Primary |
Addresses
Primary practice location
3875 S Western Ave
Los Angeles, CA 90062-1105
Mailing address
498 W. 59TH Street
San Bernardino, CA 92407
Phone (323) 290-4373
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 |
|---|---|---|---|
| PT36012 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312156800000",
"number": "1053699850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "498 W. 59TH STREET",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "92407",
"telephone_number": "323-290-4373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3875 S WESTERN AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900621105",
"telephone_number": "323-290-4373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "JACQUENE",
"middle_name": "J",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-27",
"last_updated": "2011-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "PT36012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.