Active NPI
Genesis Puente-Rangel
- Rehabilitation Practitioner
- Sacramento, CA
National Provider Identifier
1093207128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 18-54559
- Practice address
- 4540 Harlin Dr
Sacramento, CA 95826-9716 - Phone
- (916) 364-7800
- NPI assigned
- Jun 5, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 18-54559 | CA | |
| Rehabilitation Practitioner | 225400000X | 18-54559 | CA | Primary |
Addresses
Primary practice location
4540 Harlin Dr
Sacramento, CA 95826-9716
Mailing address
4540 Harlin Dr
Sacramento, CA 95826-9716
Phone (916) 364-7800
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 |
|---|---|---|---|
| 18-54559 | CA | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554076800000",
"number": "1093207128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 HARLIN DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958269716",
"telephone_number": "916-364-7800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4540 HARLIN DR",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958269716",
"telephone_number": "916-364-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUENTE-RANGEL",
"first_name": "GENESIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-05",
"last_updated": "2019-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "18-54559",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "18-54559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.