Active NPI
Kenneth Jarantilla, PA-C
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1093890659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA16032
- Practice address
- 5427 Whittier Blvd
Los Angeles, CA 90022-4101 - Phone
- (323) 869-1900
- Fax
- (323) 869-5362
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA16032 | CA | Primary |
Addresses
Primary practice location
5427 Whittier Blvd
Los Angeles, CA 90022-4101
Mailing address
5427 Whittier Blvd
Los Angeles, CA 90022-4101
Phone (323) 869-1900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121003000658 | CA | Order and Referring Only - Physician Assistant | 5890738926 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321228800000",
"number": "1093890659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5427 WHITTIER BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900224101",
"telephone_number": "323-869-1900",
"fax_number": "323-869-5362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5427 WHITTIER BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900224101",
"telephone_number": "323-869-1900",
"fax_number": "323-869-5362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JARANTILLA",
"first_name": "KENNETH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2011-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA16032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.