Active NPI
Paul Louis Provencio
- Social Worker
- San Diego, CA
National Provider Identifier
1245562743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 23582
- Practice address
- 9400 Ruffin CT
San Diego, CA 92123-5300 - Phone
- (858) 514-4867
- NPI assigned
- Feb 8, 2010
- Last updated
- Feb 8, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 23582 | CA | Primary |
Addresses
Primary practice location
9400 Ruffin CT
San Diego, CA 92123-5300
Mailing address
9400 Ruffin CT
San Diego, CA 92123-5300
Phone (858) 514-4867
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23582 | CA | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265587200000",
"number": "1245562743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9400 RUFFIN CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921235300",
"telephone_number": "858-514-4867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9400 RUFFIN CT",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921235300",
"telephone_number": "858-514-4867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVENCIO",
"first_name": "PAUL",
"middle_name": "LOUIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-08",
"last_updated": "2010-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "23582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.