Active NPI
Richard Deza
- Contractor
- Rohnert Park, CA
National Provider Identifier
1306217245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 0I65079
- Practice address
- 6095 Country Club Dr
Rohnert Park, CA 94928-2254 - Phone
- (415) 948-6552
- NPI assigned
- Oct 19, 2015
- Last updated
- Oct 19, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 0I65079 | CA | Primary |
Addresses
Primary practice location
6095 Country Club Dr
Rohnert Park, CA 94928-2254
Mailing address
6095 Country Club Dr
Rohnert Park, CA 94928-2254
Phone (415) 948-6552
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 |
|---|---|---|---|
| 0I65079 | CA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445212800000",
"number": "1306217245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6095 COUNTRY CLUB DR",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282254",
"telephone_number": "415-948-6552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6095 COUNTRY CLUB DR",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282254",
"telephone_number": "415-948-6552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEZA",
"first_name": "RICHARD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-19",
"last_updated": "2015-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "CA",
"license": "0I65079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.