Benjamin Jacob Fesagaiga, RN

Key facts

NPI

1164579322

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatric/Mental Health Registered Nurse 163WP0808X

License

519452 (CA)

Practice address

1975 Long Beach Blvd
Long Beach, CA 90806-5501

Phone

(562) 599-9401

NPI assigned

Jan 3, 2007

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Nurse

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164579322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22917 ARCHIBALD AVE",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907454716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 LONG BEACH BLVD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908065501",
            "telephone_number": "562-599-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FESAGAIGA",
        "first_name": "BENJAMIN",
        "middle_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "519452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Long Beach, CA · Psychiatric/Mental Health Registered Nurse in California