12310 Lower Azusa Rd,

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

12310 LOWER AZUSA RD,

Practice address

12310 Lower Azusa Ave
Arcadia, CA 91006

Phone

(626) 579-8593

Fax

(562) 433-1029

NPI assigned

Apr 11, 2011

Last updated

Apr 11, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kyle Fortson

Title

TCM Coordinator

Phone

(626) 579-8593

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1174813299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12310 LOWER AZUSA RD",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910065872",
            "telephone_number": "626-579-8593",
            "fax_number": "562-433-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12310 LOWER AZUSA AVE",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "91006",
            "telephone_number": "626-579-8593",
            "fax_number": "562-433-1029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "12310 LOWER AZUSA RD,",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-11",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "FORTSON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "TCM COORDINATOR",
        "authorized_official_telephone_number": "626-579-8593",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CASE MANAGER/CARE COORDINATOR",
            "identifier": "171M00000X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 1 HP
• 31 Aesthetics & Wellness Inc
• 360 Integrative Wellness, Inc.
• A & T Medical Equipment, Inc
• A and S Medical Center Inc
• A.Jayalath C. de Silva M.D. a Medical Corporation

• Case Management Agency in Arcadia, CA
• Providers in Arcadia, CA by specialty
• Case Management Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.