Active NPI
Susan Ezra, RN
- Adult Companion
- San Anselmo, CA
National Provider Identifier
1295069615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- License
- 263906
- Practice address
- 130 Greenfield Ave
San Anselmo, CA 94960-2449 - Phone
- (415) 308-7808
- NPI assigned
- Oct 1, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Adult Companion | 372600000X | 263906 | CA | Primary |
Addresses
Primary practice location
130 Greenfield Ave
San Anselmo, CA 94960-2449
Mailing address
80 Taylor Dr
Fairfax, CA 94930-1237
Phone (415) 308-7808
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 263906 | CA | MD | Adult Companion |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254355200000",
"number": "1295069615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 TAYLOR DR",
"city": "FAIRFAX",
"state": "CA",
"postal_code": "949301237",
"telephone_number": "415-308-7808"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 GREENFIELD AVE",
"city": "SAN ANSELMO",
"state": "CA",
"postal_code": "949602449",
"telephone_number": "415-308-7808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZRA",
"first_name": "SUSAN",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-01",
"last_updated": "2009-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "CA",
"license": "263906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Anselmo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.