Individual provider Active NPI

Thaghar Mansour Oda, FNP

  • Primary Care Nurse Practitioner
  • El Cajon, CA
National Provider Identifier
1063835692
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
95000205 Issued in CA
Practice address
1111 W Chase Ave
El Cajon, CA 92020-5710
Phone
(619) 515-2499
NPI assigned
Feb 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NPF95000205 CA
Primary Care Nurse Practitioner 363LP2300X 95000205 CA Primary

Addresses

Primary practice location

1111 W Chase Ave
El Cajon, CA 92020-5710

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Other practice location 1

4060 Fairmount Ave
San Diego, CA 92105-1608
Phone (619) 584-1612

Other practice location 2

133 W Main St
El Cajon, CA 92020-3315
Phone (619) 401-0404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161122002302 CA Practitioner - Nurse Practitioner 2163701723 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1809 National Ave
San Diego, CA 92113-2113
Phone (619) 515-2300

5160 Federal Blvd
San Diego, CA 92105-5429
Phone (619) 515-2454

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NPF95000205CAMDFamily Nurse Practitioner
95000205CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Arwinnah Bautista MD, PC CurrentSince Jan 1, 2019 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jan 4, 2021 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jan 4, 2021 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients

Locations

1111 W Chase Ave
El Cajon, CA 92020
Phone (619) 515-2499

1430 E Plaza Blvd
Ste E18
National City, CA 91950
Phone (619) 267-0553

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1391385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1063835692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W CHASE AVE",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920205710",
            "telephone_number": "619-515-2499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4060 Fairmount Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921051608",
            "country_code": "US",
            "telephone_number": "619-584-1612",
            "fax_number": "619-285-8134",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "133 W Main St",
            "address_purpose": "LOCATION",
            "city": "El Cajon",
            "state": "CA",
            "postal_code": "920203315",
            "country_code": "US",
            "telephone_number": "619-401-0404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODA",
        "first_name": "THAGHAR",
        "middle_name": "MANSOUR",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-03",
        "last_updated": "2021-01-05",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NPF95000205",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95000205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Cajon, CA

Sources for this page

Verify at the official NPI Registry.