Antara Leonid De Bourbon, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

764892 Issued in CA

Practice address

400 Red Hawk LN
Aptos, CA 95003-2668

Phone

(831) 588-8871

NPI assigned

Oct 14, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1265717896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RED HAWK LN",
            "city": "APTOS",
            "state": "CA",
            "postal_code": "950032668",
            "telephone_number": "831-588-8871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 RED HAWK LN",
            "city": "APTOS",
            "state": "CA",
            "postal_code": "950032668",
            "telephone_number": "831-588-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE BOURBON",
        "first_name": "ANTARA",
        "middle_name": "LEONID",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "764892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• D.K. Bullard Inc.
• Badri Dass, PHD
• David J Montgomery DDS
• David M. Okuji, D.D.S., Inc.
• Donald Lewis Davies, M.D.
• Molly Quigley De Mesa, DTCM, L.AC.
• Kimberly Ann De Serpa, L.C.S.W.
• Dearborn & Associates Institute for Joint Restoration
• Lisa Defaria, MSW/LCSW
• Brian Del Core, D.D.S.

• Registered Nurse in Aptos, CA
• Providers in Aptos, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.