Edita Untalan

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

Practice address

4713 Boxford Rd
VA Beach, VA 23456-5009

Phone

(757) 376-1755

NPI assigned

Oct 11, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1083256077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 BOXFORD RD",
            "city": "VA BEACH",
            "state": "VA",
            "postal_code": "234565009",
            "telephone_number": "757-376-1755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 BOXFORD RD",
            "city": "VA BEACH",
            "state": "VA",
            "postal_code": "234565009",
            "telephone_number": "757-376-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNTALAN",
        "first_name": "EDITA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "address_1": "4713 Boxford Rd",
            "city": "VA Beach",
            "state": "VA",
            "country_code": "US",
            "postal_code": "234565009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Attendant Care Provider in VA Beach, VA
• Providers in VA Beach, VA by specialty
• Attendant Care Provider in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.