Individual provider Active NPI

Theresa Cecilia Desmond, R.N.

  • Registered Nurse
  • San Luis Obispo, CA
National Provider Identifier
1295893444
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
405212 Issued in CA
Practice address
2178 Johnson Ave
San Luis Obispo, CA 93401-4535
Phone
(805) 781-4700
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 405212 CA Primary

Addresses

Primary practice location

2178 Johnson Ave
San Luis Obispo, CA 93401-4535

Mailing address

2178 Johnson Ave
San Luis Obispo, CA 93401-4535
Phone (805) 781-4700

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

LicenseStateTypeSpecialty
405212CAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295893444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2178 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014535",
            "telephone_number": "805-781-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2178 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014535",
            "telephone_number": "805-781-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESMOND",
        "first_name": "THERESA",
        "middle_name": "CECILIA",
        "name_prefix": "Ms.",
        "credential": "R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "405212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.