Active NPI
Rita Phetmixay
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1104227396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 109144
- Practice address
- 470 E 3Rd St Ste C
Los Angeles, CA 90013-1630 - Phone
- (213) 620-5712
- NPI assigned
- Sep 8, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 87669 | CA | |
| Clinical Social Worker | 1041C0700X | 109144 | CA | Primary |
Addresses
Primary practice location
470 E 3Rd St Ste C
Los Angeles, CA 90013-1630
Mailing address
470 E 3Rd St Ste C
Los Angeles, CA 90013-1630
Phone (213) 620-5712
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 |
|---|---|---|---|
| 87669 | CA | MD | Mental Health Counselor |
| 109144 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658707200000",
"number": "1104227396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "470 E 3RD ST STE C",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900131630",
"telephone_number": "213-620-5712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "470 E 3RD ST STE C",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900131630",
"telephone_number": "213-620-5712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHETMIXAY",
"first_name": "RITA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-08",
"last_updated": "2022-07-25",
"certification_date": "2022-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "87669",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "109144",
"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 Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.