Jennifer Miranda Vicente, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

NP95002008 Issued in CA

Practice address

3300 E South St Ste 205
Lakewood, CA 90805-4587

Phone

(562) 531-0377

NPI assigned

Mar 12, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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

• Prohealth Partners, a Medical Group

  • Internal Medicine Physician
  • Lakewood, CA
  • NPI 1003949975
  Medicare reassignment NPD
• Prohealth Partners a Medical Group Inc

  • Family Medicine Physician
  • Long Beach, CA
  • NPI 1447382411
  NPD
• Prohealth Partners, a Medical Group, Inc.

  • Family Medicine Physician
  • Long Beach, CA
  • NPI 1821121542
  NPD
• Prohealth Partners, a Medical Group, Inc.

  • Internal Medicine Physician
  • Pico Rivera, CA
  • NPI 1912899394
  NPD
• Prohealth Partners a Medical Group Inc

  • Internal Medicine Physician
  • Lakewood, CA
  • NPI 1093848509
  NPD (past)

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

{
    "created_epoch": "1426118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426118400000",
    "number": "1235522483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6742 GLORYWHITE ST",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907132222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST STE 205",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054587",
            "telephone_number": "562-531-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICENTE",
        "first_name": "JENNIFER",
        "middle_name": "MIRANDA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-12",
        "last_updated": "2015-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "NP95002008",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "NP95002008",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Veith
• Mario Enrique Velasquez Jr.
• Emily Venegas
• Vincent Anthony Verduzco
• Laia Vicens-Fuste, CLINICAL SOCIAL WORK
• Jann-Eric Victoriano, PT, DPT
• Sonia Vicuna-Gudino
• Vigilance Anesthesia Medical Group
• Vigilance Perioperative Medical Group
• Wendy Villafranco, DOULA

• Adult Health Nurse Practitioner in Lakewood, CA
• Providers in Lakewood, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.