Active NPI
Kalicia Burrell
- Peer Specialist
- Los Angeles, CA
National Provider Identifier
1174908966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 8300 S Vermont Ave
Los Angeles, CA 90044 - Phone
- (323) 525-6400
- Fax
- (323) 565-2133
- NPI assigned
- Jul 22, 2015
- Last updated
- Jun 26, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | NU | ||
| Peer Specialist | 175T00000X | NU | Primary |
Addresses
Primary practice location
8300 S Vermont Ave
Los Angeles, CA 90044
Mailing address
1045 W Redondo Beach Blvd Ste 300
Gardena, CA 90247-4175
Phone (323) 241-6730
Other practice location 1
6055 E Washington Blvd
Commerce, CA 90040-2449
Phone (323) 346-0960
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1174908966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1045 W REDONDO BEACH BLVD STE 300",
"city": "GARDENA",
"state": "CA",
"postal_code": "902474175",
"telephone_number": "323-241-6730",
"fax_number": "323-967-0614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8300 S VERMONT AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90044",
"telephone_number": "323-525-6400",
"fax_number": "323-565-2133"
}
],
"practiceLocations": [
{
"address_1": "6055 E Washington Blvd",
"address_purpose": "LOCATION",
"city": "Commerce",
"state": "CA",
"postal_code": "900402449",
"country_code": "US",
"telephone_number": "323-346-0960",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BURRELL",
"first_name": "KALICIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-22",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.