Active NPI
Dawn Denise Deberry, NP
- Gerontology Nurse Practitioner
- Cerritos, CA
National Provider Identifier
1124314224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 18869
- Practice address
- 12900 Park Plaza Dr
# 150
Cerritos, CA 90703-9329 - Phone
- (866) 646-3553
- NPI assigned
- Jun 27, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 18869 | CA | Primary |
Addresses
Primary practice location
12900 Park Plaza Dr
# 150
Cerritos, CA 90703-9329
Mailing address
12900 Park Plaza Dr
# 150
Cerritos, CA 90703-9329
Phone (866) 646-3553
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18869 | CA | MD | Speech-Language Pathologist |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- dawn.deberry@kcc.eclinicaldirectplus.com
- dawn.deberry.p1@direct.scfhc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309132800000",
"number": "1124314224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12900 PARK PLAZA DR",
"address_2": "# 150",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907039329",
"telephone_number": "866-646-3553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12900 PARK PLAZA DR",
"address_2": "# 150",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907039329",
"telephone_number": "866-646-3553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBERRY",
"first_name": "DAWN",
"middle_name": "DENISE",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-27",
"last_updated": "2011-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "CA",
"license": "18869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cerritos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.