Active NPI
Priscilla Purushothaman
- Speech-Language Pathologist
- Santa Clara, CA
National Provider Identifier
1093486169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 15959
- Practice address
- 1880 Pruneridge Ave
Santa Clara, CA 95050-6514 - Phone
- (267) 806-8512
- NPI assigned
- Sep 27, 2021
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 15959 | CA | Primary |
Addresses
Primary practice location
1880 Pruneridge Ave
Santa Clara, CA 95050-6514
Mailing address
4251 Norwalk Dr Apt Aa208
San Jose, CA 95129-1726
Phone (267) 806-8512
Other practice location 1
897 Broadleaf Ln
San Jose, CA 95128-1314
Phone (267) 806-8512
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 |
|---|---|---|---|
| 15959 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1093486169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4251 NORWALK DR APT AA208",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951291726",
"telephone_number": "267-806-8512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 PRUNERIDGE AVE",
"city": "SANTA CLARA",
"state": "CA",
"postal_code": "950506514",
"telephone_number": "267-806-8512"
}
],
"practiceLocations": [
{
"address_1": "897 Broadleaf Ln",
"address_purpose": "LOCATION",
"city": "San Jose",
"state": "CA",
"postal_code": "951281314",
"country_code": "US",
"telephone_number": "267-806-8512",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PURUSHOTHAMAN",
"first_name": "PRISCILLA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-27",
"last_updated": "2021-09-27",
"certification_date": "2021-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "15959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Clara, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.