Active NPI
Susan K Nakaya Avila
- Occupational Therapy Assistant
- San Gabriel, CA
National Provider Identifier
1083950877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 500
- Practice address
- 115 Bridge St
San Gabriel, CA 91775-2719 - Phone
- (626) 289-4439
- NPI assigned
- Dec 24, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 500 | CA | Primary |
Addresses
Primary practice location
115 Bridge St
San Gabriel, CA 91775-2719
Mailing address
115 Bridge St
San Gabriel, CA 91775-2719
Phone (626) 289-4439
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500 | Medicaid | CA |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420588800000",
"number": "1083950877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 BRIDGE ST",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917752719",
"telephone_number": "626-289-4439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 BRIDGE ST",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917752719",
"telephone_number": "626-289-4439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAKAYA AVILA",
"first_name": "SUSAN",
"middle_name": "K",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-24",
"last_updated": "2015-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "CA",
"license": "500",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Gabriel, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.