Individual provider Active NPI

Nancy C Lavine-Anderson, OTR,L

  • Public Health or Welfare Agency
  • San Diego, CA
National Provider Identifier
1083741102
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
License
0T3155 Issued in CA
Practice address
6160 Mission Gorge Rd
Suite# 305
San Diego, CA 92120-3410
Phone
(619) 528-4081
Fax
(619) 528-4026
NPI assigned
Feb 27, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 0T3155 CA Primary

Addresses

Primary practice location

6160 Mission Gorge Rd
Suite# 305
San Diego, CA 92120-3410

Mailing address

5320 Wellesley St
La Mesa, CA 91942-4446
Phone (619) 528-4081

Other identifiers 1

IdentifierTypeStateIssuer
OT3155OtherCAOT LICENSE

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
0T3155CAMDPublic Health or Welfare Agency

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083741102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 WELLESLEY ST",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919424446",
            "telephone_number": "619-528-4081",
            "fax_number": "619-528-4026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 MISSION GORGE RD",
            "address_2": "SUITE# 305",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921203410",
            "telephone_number": "619-528-4081",
            "fax_number": "619-528-4026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVINE-ANDERSON",
        "first_name": "NANCY",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "OTR,L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "CA",
            "license": "0T3155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OT LICENSE",
            "identifier": "OT3155",
            "state": "CA"
        }
    ],
    "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 Jul 8, 2007; 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.