Active NPI
Susan Medina
- Rehabilitation Practitioner
- La Puente, CA
National Provider Identifier
1184899379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 160 S 7TH Ave
La Puente, CA 91746-3211 - Phone
- (626) 626-4200
- Fax
- (626) 626-4201
- NPI assigned
- Apr 28, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | Primary | ||
| Case Manager/Care Coordinator | 171M00000X |
Addresses
Primary practice location
160 S 7TH Ave
La Puente, CA 91746-3211
Mailing address
PO Box 706
Burbank, CA 91503-0706
Phone (626) 826-9910
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ICAN803 | Other | CA | LA COUNTY DMH STAFF CODE |
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": "1209340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283126400000",
"number": "1184899379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 706",
"city": "BURBANK",
"state": "CA",
"postal_code": "915030706",
"telephone_number": "626-826-9910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 S 7TH AVE",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917463211",
"telephone_number": "626-626-4200",
"fax_number": "626-626-4201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "SUSAN",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-28",
"last_updated": "2010-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA COUNTY DMH STAFF CODE",
"identifier": "ICAN803",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Puente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.