Individual provider Active NPI

Tattyanna Frescas

  • Licensed Vocational Nurse
  • San Pedro, CA
National Provider Identifier
1174334163
Registry record updated Aug 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
744859 Issued in CA
Practice address
270 W 14TH St
San Pedro, CA 90731-4396
Phone
(310) 519-8723
NPI assigned
Jan 17, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 744859 CA Primary

Addresses

Primary practice location

270 W 14TH St
San Pedro, CA 90731-4396

Mailing address

12021 Wilmington Ave
Building 18 Suite 101
Los Angeles, CA 90059-3019
Phone (424) 454-6001

Other practice location 1

12021 Wilmington Ave
Building 18 suite 101
Los Angeles, CA 90059-3019
Phone (424) 454-6001

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

State licenses

LicenseStateTypeSpecialty
744859CAMDLicensed Vocational Nurse

NPI Registry JSON

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

{
    "created_epoch": "1737072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754870400000",
    "number": "1174334163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 WILMINGTON AVE",
            "address_2": "BUILDING 18 SUITE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "424-454-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 W 14TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907314396",
            "telephone_number": "310-519-8723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12021 Wilmington Ave",
            "address_2": "Building 18 suite 101",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900593019",
            "country_code": "US",
            "telephone_number": "424-454-6001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRESCAS",
        "first_name": "TATTYANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-17",
        "last_updated": "2025-08-11",
        "certification_date": "2025-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "744859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; 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.