Individual provider Active NPI

Marilyn Rosca, NURSE PRACTITIONER

  • Gerontology Nurse Practitioner
  • Lakewood, CA
National Provider Identifier
1194177188
Registry record updated Jul 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
95004493 Issued in CA
Practice address
12234 Renville St
Lakewood, CA 90715-1605
Phone
(562) 228-6346
NPI assigned
Jul 1, 2016
Last updated
Jul 1, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 95004493 CA Primary

Addresses

Primary practice location

12234 Renville St
Lakewood, CA 90715-1605

Mailing address

12234 Renville St
Lakewood, CA 90715-1605
Phone (562) 228-6346

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
I20170523002847 CA Practitioner - Nurse Practitioner 1850668898 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altea Medical California PCGroup PAC ID 1850740150, 84 clinicians
Meher F Tabatabai M D IncGroup PAC ID 3173695111, 8 clinicians

Practice addresses (Care Compare)

2353 23Rd St
Eureka, CA 95501-3201
Phone (707) 445-3261

3621 Martin Luther King Jr Blvd
Suite 6
Lynwood, CA 90262-3512
Phone (310) 537-1503

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Meher F Tabatabai MD Inc CurrentSince Apr 15, 2017 Accepting new patients
Altea Medical California PC CurrentSince Mar 2, 2024 Accepting new patients
Gastro-Digestive Medical Group CurrentSince Oct 7, 2024 Accepting new patients

Locations

400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297

11480 Brookshire Ave
Ste 308
Downey, CA 90241
Phone (562) 862-3656

2353 23rd St
Eureka, CA 95501
Phone (704) 445-3261

2885 Harris St
Eureka, CA 95503
Phone (707) 443-1627

2321 Newburg Rd
Fortuna, CA 95540
Phone (707) 725-4457

5696 Lake Murray Blvd
La Mesa, CA 91942
Phone (619) 460-5225

3621 Martin Luther King Jr Blvd
Ste 6
Lynwood, CA 90262
Phone (310) 537-1503

517 S A St
Madera, CA 93638
Phone (559) 673-9228

2424 M St
Merced, CA 95340
Phone (209) 473-3896

2124 57th Ave
Oakland, CA 94621
Phone (510) 261-2628

39950 Vista del Sol
Rancho Mirage, CA 92270
Phone (760) 340-0053

3000 N Gate Rd
Seal Beach, CA 90740
Phone (562) 594-5790

2005 River St
Susanville, CA 96130
Phone (530) 257-5341

13333 Fenton Ave
Sylmar, CA 91342
Phone (818) 367-1033

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IJEEBA

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1467331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1194177188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12234 RENVILLE ST",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907151605",
            "telephone_number": "562-228-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12234 RENVILLE ST",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907151605",
            "telephone_number": "562-228-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSCA",
        "first_name": "MARILYN",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-01",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95004493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CA

Sources for this page

Verify at the official NPI Registry.