Individual provider Active NPI

Debbie Raj, COTA/L

  • Assisted Living Facility
  • Manteca, CA
National Provider Identifier
1134580244
Registry record updated Mar 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
2220 Issued in CA
Practice address
469 E North St
Manteca, CA 95336-4710
Phone
(209) 823-1788
NPI assigned
Mar 16, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 2220 CA Primary

Addresses

Primary practice location

469 E North St
Manteca, CA 95336-4710

Mailing address

469 E North St
Manteca, CA 95336-4710
Phone (209) 823-1788

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

LicenseStateTypeSpecialty
2220CAMDClinical Nurse Specialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458086400000",
    "number": "1134580244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "469 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364710",
            "telephone_number": "209-823-1788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "469 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364710",
            "telephone_number": "209-823-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJ",
        "first_name": "DEBBIE",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-16",
        "last_updated": "2016-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "2220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteca, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.