James Robert Etteldorf, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10542 Issued in CA

Practice address

11234 Anderson St
Loma Linda, CA 92354-2804

Phone

(909) 558-8514

NPI assigned

Feb 28, 2007

Sex

Male

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164559761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2242 BLACK OAK PL",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925064603",
            "telephone_number": "951-686-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-8514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTELDORF",
        "first_name": "JAMES",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "10542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ignacio Minguillan Estrada
• Maria De Jesus Estrada
• Ryan Michael Estrada, LVN
• Amanda Leeann Etheridge, M.D.
• Teresa Ethridge
• Evan Hyun-Jin Chung MD Inc
• Nicole Evangelista
• Dwight Charles Evans, M.D.
• Erica Jinhee Evans, MD
• Tiare Nicole Evans, M.D.

• Family Nurse Practitioner in Loma Linda, CA
• Providers in Loma Linda, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.