Individual provider Active NPI

Mary Q Tu, NP

  • Licensed Practical Nurse
  • Monterey Park, CA
National Provider Identifier
1164769295
Registry record updated Jan 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
22173 Issued in CA
Practice address
500 N Garfield Ave
Suite 102
Monterey Park, CA 91754-1242
Phone
(626) 288-0488
NPI assigned
Jan 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 22173 CA Primary

Addresses

Primary practice location

500 N Garfield Ave
Suite 102
Monterey Park, CA 91754-1242

Mailing address

500 N Garfield Ave
Suite 102
Monterey Park, CA 91754-1242
Phone (626) 288-0488

Other identifiers 1

IdentifierTypeStateIssuer
22173OtherCASTATE LICENSE

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250605003285 CA Order and Referring Only - Nurse Practitioner 5294974143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
22173CAMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357689600000",
    "number": "1164769295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N GARFIELD AVE",
            "address_2": "SUITE 102",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917541242",
            "telephone_number": "626-288-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N GARFIELD AVE",
            "address_2": "SUITE 102",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917541242",
            "telephone_number": "626-288-0488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TU",
        "first_name": "MARY",
        "middle_name": "Q",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-09",
        "last_updated": "2013-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CA",
            "license": "22173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "22173",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monterey Park, CA

Sources for this page

Verify at the official NPI Registry.