Active NPI
Lavanta Green
- Student in an Organized Health Care Education/Training Program
- Pittsburg, CA
National Provider Identifier
1164091740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 51 Marina Blvd
Pittsburg, CA 94565-2068 - Phone
- (925) 252-1111
- NPI assigned
- Jun 18, 2021
- 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | CA | Primary |
Addresses
Primary practice location
51 Marina Blvd
Pittsburg, CA 94565-2068
Mailing address
5000 Woodmont Way
Antioch, CA 94531-8142
Phone (925) 778-9498
Other practice location 1
1266 14th St
Oakland, CA 94607-2247
Phone (510) 882-7791
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15069212 | Other | CA | KAISER PERMANENTE |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lighthouse Mentoring Center | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Social Worker
- Antioch, CA
- NPI 1750104881
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623974400000",
"number": "1164091740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 WOODMONT WAY",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945318142",
"telephone_number": "925-778-9498",
"fax_number": "925-778-9498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 MARINA BLVD",
"city": "PITTSBURG",
"state": "CA",
"postal_code": "945652068",
"telephone_number": "925-252-1111"
}
],
"practiceLocations": [
{
"address_1": "1266 14th St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946072247",
"country_code": "US",
"telephone_number": "510-882-7791",
"fax_number": "510-531-0258",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GREEN",
"first_name": "LAVANTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-18",
"last_updated": "2021-06-18",
"certification_date": "2021-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER PERMANENTE",
"identifier": "15069212",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittsburg, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.