Active NPI
Raygenald Jacques Pierre, COTA/L
- Developmental Therapist
- Garden Grove, CA
National Provider Identifier
1124450325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- 1438
- Practice address
- 11031 Jerry LN
Garden Grove, CA 92840-3318 - Phone
- (619) 840-6043
- NPI assigned
- Jul 30, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | 1438 | CA | Primary |
Addresses
Primary practice location
11031 Jerry LN
Garden Grove, CA 92840-3318
Mailing address
11031 Jerry LN
Garden Grove, CA 92840-3318
Phone (619) 840-6043
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 |
|---|---|---|---|
| 1438 | CA | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375142400000",
"number": "1124450325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11031 JERRY LN",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928403318",
"telephone_number": "619-840-6043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11031 JERRY LN",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928403318",
"telephone_number": "619-840-6043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PIERRE",
"first_name": "RAYGENALD",
"middle_name": "JACQUES",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-30",
"last_updated": "2013-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "CA",
"license": "1438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.