Garry Roger Dormevil, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024180743 Issued in VA

Practice address

79440 Corporate Center Dr Ste 100
La Quinta, CA 92253-7243

Phone

(805) 719-3700

Fax

(805) 413-9099

NPI assigned

Aug 2, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: garry.dormevil.p1@direct.ifh.nextgenshare.com

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1164196457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 S STATE COLLEGE BLVD STE 350",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928215814",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79440 CORPORATE CENTER DR STE 100",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922537243",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 N Mountain Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Upland",
            "state": "CA",
            "postal_code": "917865183",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27555 Ynez Rd Ste 370",
            "address_purpose": "LOCATION",
            "city": "Temecula",
            "state": "CA",
            "postal_code": "925914678",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "501 N Central Ave",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "912031901",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24012 Calle De La Plata Ste 230",
            "address_purpose": "LOCATION",
            "city": "Laguna Hills",
            "state": "CA",
            "postal_code": "926537623",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2720 N Harbor Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928352626",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2121 Wilshire Blvd Ste 303",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904035743",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "77 Rolling Oaks Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913611018",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "23456 Hawthorne Blvd Ste 140",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905054716",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4520 Executive Dr Ste 227",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921213020",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 University Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958256535",
            "country_code": "US",
            "telephone_number": "805-719-3700",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DORMEVIL",
        "first_name": "GARRY",
        "middle_name": "ROGER",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-02",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024180743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in La Quinta, CA
• Providers in La Quinta, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.

Verify at the official NPI Registry.