Active NPI
Jennifer Petty
- Audiology Assistant
- Los Angeles, CA
National Provider Identifier
1306085196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiology Assistant
- License
- SPA 953
- Practice address
- 4160 Grand View Blvd
Los Angeles, CA 90066-5214 - Phone
- (310) 751-1101
- Fax
- (310) 397-5827
- NPI assigned
- Feb 18, 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 |
|---|---|---|---|---|
| Audiology Assistant | 2355A2700X | SPA 953 | CA | Primary |
Addresses
Primary practice location
4160 Grand View Blvd
Los Angeles, CA 90066-5214
Mailing address
4160 Grand View Blvd
Los Angeles, CA 90066-5214
Phone (310) 751-1101
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 |
|---|---|---|---|
| SPA 953 | CA | MD | Audiology Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234915200000",
"number": "1306085196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4160 GRAND VIEW BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900665214",
"telephone_number": "310-751-1101",
"fax_number": "310-397-5827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4160 GRAND VIEW BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900665214",
"telephone_number": "310-751-1101",
"fax_number": "310-397-5827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "JENNIFER",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-18",
"last_updated": "2009-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "2355A2700X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Audiology Assistant",
"state": "CA",
"license": "SPA 953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.